Pocket Podiatry: Paediatrics by Evans Angela Margaret & Evans Angela Margaret

Author:Evans, Angela Margaret & Evans, Angela Margaret
Language: eng
Format: epub
ISBN: 978-0-7020-3031-4
Publisher: Elsevier Health Sciences UK
Published: 2010-01-25T16:00:00+00:00

Basic pathology

The congenital idiopathic clubfoot deformity is identified by the presence of a retracted and inverted heel (equinus), usually a medial crease on the plantar aspect of the adducted forefoot and longitudinal arch cavus. Pathognomonic to this deformity is the inability to be able to bring the foot to a plantigrade position. In unilateral cases, the clubfoot is comparatively stiff, smaller with leg muscle atrophy and shortening also common.

In terms of aetiology, a normally developing foot deforms at approximately the 16th fetal week to become a clubfoot. While genetics and environmental influences are both probable contributors, it is curious to note that a more precise mechanism(s) of aetiology is still unknown. The primary deformity centres on the shape and position of the talus and the related misplacement of the navicular.

The Ponseti method focuses on stabilizing the talus and reducing the clubfoot deformity by abducting the inverted forefoot. This allows for the calcaneus to abduct, which, in turn, allows for the ankle to be dorsiflexed (often necessitating lengthening of the Achilles tendon) (Pandey & Pandey 2003; Ponseti 1997; Ponseti et al 2003, 2006).

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