Congenital and positional clubfoot of the newborn child
1. What it is
Congenital clubfoot of the newborn child is a foot malformation (and leg) that presents itself in incorrect position since birth.
When this issue is mentioned, it almost always means clubfoot equine-cable-adducted-supinateas this presentation is certainly the most frequent.
What does this medical definition mean? I will explain it briefly.
The term club-foot equine-hollow-adducted-supinate is intended the following:
- The foot is turned inwards and toe downwards (equinus)
- being bent inwards, the plantar vault is curved (hollow)
- the heel is deflected inwards when the foot is viewed from behind (varus)
- the sole of the foot is turned inwards and upwards (adducted and supinated)
Clubfoot is defined as such when, when manipulated to assume a ''normal'' position, it tends to reoccur and cannot maintain the correct position.
Obviously, even from a simple visual observation it does not appear straight but blatantly ''crooked''.
2. Incidence of congenital clubfoot
Congenital clubfoot is one of the most common congenital malformations of the joints of infants.
According to an article by the Italian Society of Paediatrics, congenital clubfoot has a prevalence of 1-4.5 per 1,000 live births and prefers the male sex, with a ratio of approximately 3:1 compared to the female sex.
It mainly affects the right side, but is often bilateral (50%).
It is associated with other malformations in 7% of cases and eredo-familiarity can be found in 15% of cases (Zionts et al., 2015; Goldstein et al., 2015).
According to the Italian Register of Congenital Defects (1994- 2006), the incidence in our country is 0.8-1.65 per 1000 live births.
3. The causes
Le causes of congenital clubfoot are, in the majority of cases, unknown and that is why it is called ''idiopathic clubfoot''.
This pathology has a aetiology definitely multifactorialcauses of both interaction environmental either genetic ( bothnfluence the shape of the foot already during intrauterine life).
Only in rare cases, fortunately, is congenital clubfoot associated with more serious problems or part of a syndromic picture (neurological problems, spina bifida, arthrogryposis, other syndromic pictures...).
The paediatrician or paediatric orthopaedist will certainly take these parameters into account in order to make a correct diagnostic and prognostic assessment.
4. Congenital clubfoot vs positional clubfoot
It is important to know that there is not only congenital clubfoot but also a twisted foot from position.
This issue is caused by some incorrect positions that the child maintained during pregnancy (due to a reduction in amniotic fluid, a malformation of the uterus or a simple malposition).
The positioning (incorrectly) maintained in the belly affects its appearance even after birth.
La difference The difference between congenital clubfoot and positional clubfoot is that the former is very stiff and marked, the latter is milder and should tend to improve gradually over the months.
What I would like to emphasise is to always pay attention to the positioning of the infant's foot In fact, sometimes the extent of positional clubfoot is underestimated with the result that the child maintains incorrect positioning over the months.
In such cases, paediatric osteopathy is very effective in resolving these types of positional clubfoot.
5. Diagnosis of congenital or positional clubfoot
Thanks to modern medical equipment and ultrasound precision, the suspicion of clubfoot can already occur during pregnancy (obviously through morphological ultrasound). In such cases, the diagnosis will be confirmed after the birth of the child by the doctor's clinical assessment.
In general, the diagnosis of this problem occurs after birth and is always based on the clinical diagnosis (through observation and palpation of the foot and leg in an incorrect position).
Once parents become aware of the problem, they will be advised to visit a paediatric orthopaedic specialist who will assess the severity of the problem, distinguishing a congenital clubfoot from a positional clubfoot.
From this assessment will derive the subsequent therapies to resolve it.
6. Cures and treatments for idiopathic congenital clubfoot
La diagnosis of congenital or positional clubfoot is corthopaedic/pediatric ompetence.
The most well-known therapy in recent decades is the Ponseti Method which is based on the application of corrective chalks applied to the child.
For more on this topic, I invite you to read the article The treatment of idiopathic congenital clubfoot with the Ponseti Method.
When the clubfoot is positionalgenerally speaking, we are talking about a mild or moderate problem, which can be reduced manually.
As mentioned above, in these cases it is crucial never to underestimate the problem as positional clubfoot does not always resolve itself.
First of all, it is important to emphasise that due to a retained intrauterine malposition the child's foot and leg may have developed joint stiffness and contractures muscular foot and leg.
This is why it is always very useful to perform an osteopathic examination whose task is to assess and resolve the presence of joint tensions and muscular contractures that may be present in the child. If these are not resolved, they will procrastinate the positional clubfoot or prevent it from resolving itself.
In my clinical experience I see numerous infants from the first weeks of life with positional clubfeet and resolve them within 3-5 sessions. In fact, thanks to gentle treatments of the plantar vault muscles, the calf and the leg, it is possible to solve the problem.
In addition, I usually teaching parents a massage at the level of the sole of the foot, the calf, the front part of the tibial muscles of the leg and the thigh. This gives the best results as the parents can continue the work done in the studio with my treatments at home.
7. Other types of clubfoot
The term clubfoot is generically understood as an alteration in the correct positioning of the foot and leg.
In addition to the idiopathic congenital clubfoot and positional clubfoot types, there are other lesser-known types; let's look at some of them.
Metatarsus varus
This terminology means that the front half of the foot is turned inwards.
To explain further, imagine as if the foot were split lengthwise into two parts, a back half and a front half; lo and behold, the front half tilts inwards.
hence the term metatarsus (i.e. the front part of the foot) varus (i.e. turned inwards).
In most cases, this deformity is not rigid (i.e. it is not pathological and does not require orthopaedic surgery) but resolves itself with the right manipulations.
By manipulations I mean treatments of the muscles of the foot and leg that govern the positioning of the foot.
NB: it is extremely important to carry out the treatments because very often these problems do not resolve themselves and, if prolonged, can lead to plantar and postural alterations in the long term.
pronated talus valgus
This positional deformity presents itself with foot extended upwards (towards the leg) and pronate (i.e. the plant looks outwards).
It can occur in a more or less pronounced manner and, almost always, it is a deformity caused by intrauterine malpositioning of the child's feet.
To solve this incorrect foot positioning, in addition to possible spontaneous improvement, manual treatments are always necessary to decontract the foot and leg muscles and improve joint mobility.
If not treated in a timely manner, these difficulties are maintained throughout the child's growth, negatively influencing the child's plantar support and postural development.
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