Club foot in child pediatric nursing. Brief presentation It includes Introduction Definition Risk factors Etiology Classification Sign and symptoms Management Nursing diagnosis

1. Club
Foot(Congenit
al Talipes
Equinovarus)
By Ritik
Bsc nursing
Santosh nursing college

2. INTRODUCTION
01

3. Club foot is a congenital abnormally of the
foot and lower leg involving abnormality of
bone are structural and soft tissue
The foot may be divided into forefoot,
midfoot and the hind foot.
INTRODUCTION

5. DEFINITION
The term clubfoot is used to describe
a common deformity in which the foot
is twisted out of its normal shape or
position. Any foot deformity involving
the ankle is known as”tallipes”
derived from “talus” meaning ankle
and “pes” meaning foot.

8. INCIDENCE.
● Occurs approx. in 1-2of every 1000
live birth.
● In affected families, clubfeet are
about 30 times more frequent in
offspring.
● Male are affected in about 65% of
case

9. RISK FACTORS
● Risk factors include:
● Sex. Clubfoot is more common in males.
● Family history. If either one of the parents or their
other children have had clubfoot, the baby is more
likely to have it as well. It’s also more common if
the baby has another birth defect.
● Smoking during pregnancy. If a woman with a
family history of clubfoot smokes during
pregnancy, her baby’s risk of the condition may be
20 times greater than average.

10. RISK FACTORS
● Not enough amniotic fluid during pregnancy.
Too little of the fluid that surrounds the baby in the
womb may increase the risk of clubfoot.
● Getting an infection or using illicit drugs during
pregnancy. These can increase the risk of
clubfoot as well.

11. Causes
● The cause of clubfoot is unknown (idiopathic). But scientists do
know that clubfoot is not caused by the position of the baby in the
womb (fetus).
● In some cases, clubfoot can be associated with other abnormalities
of the skeleton that are present at birth (congenital), such as spina
bifida.
● Clubfoot can also be the result of problems that affect the nerve,
muscle, and bone systems, such as stroke or brain injury.
● Extrinsic associations include teratogenic agents (eg, sodium
aminopterin), oligohydramnios, and congenital constriction rings

12. TYPES
CLUB FOOT
Talipes
varus
Talipes
calcaneu
s
Talipes
equinus
Talipes
equinovarus
Talipes valus

13. 1. Talipes varus : there is an inversion or bending inward of
foot
2. Talipes valgus : there is an eversion or bending outward of
foot
3. Talipes equinue : there is planter flexion and toe is lower
than heel
4. Talipes calcaneus : there is dorsiflexion and toe higher
than heel
5. Talipes equinovarus : the foot is in plantar flexion(cavus)
and adductus and hindfoot demonstrates.
Type

14. CLINICAL FEATURES
1. Malposition of the Foot
2. Equinus Deformity
3. Hindfoot Varus
4. Forefoot Adduction
5. Midfoot Cavus
6. Tight Achilles
7. Muscular Imbalance
8. Smaller Foot Size
9. Limited Range of Motion

15. ASSOCIATED ABNORMALY
1. Other Musculoskeletal Abnormalities: such as hip dysplasia,
limb length discrepancy, or spinal abnormalities like scoliosis.
2. Congenital Conditions: spina bifida, a neural tube defect affecting
the spine; and Larsen syndrome
3. Neuromuscular Disorders: such as cerebral palsy, spinal
muscular atrophy, or myelomeningocele
4. Metabolic Disorders: such as mucopolysaccharidosis and
diastrophic dysplasia, have been associated with the development
of clubfoot.
5. Genetic Factors: Having a family history of clubfoot increases the
risk of a child developing the condition.

16. 1. Medical History: The healthcare provider will begin by
gathering information about the patient’s medical history,
including any known risk factors or family history of clubfoot.
2. Physical Examination: A thorough physical examination of
the affected foot is essential to assess the severity and
characteristics of the clubfoot. The healthcare provider will
look for the following signs:
● Abnormal foot position: The foot may be turned inward and
downward, with the sole facing inward.
Diagnostic evaluation

17. ● Muscle tightness or atrophy: The calf muscles
may appear smaller or tighter on the affected side.
● Skin creases: Abnormal or absent skin creases
may be observed around the foot and ankle.
● Deformities: The bones and joints of the foot will
be examined for any bony abnormalities or joint
contractures.
● Limited range of motion: The foot may have a
restricted range of motion, particularly in the ankle
and subtalar joints.
Diagnostic evaluation

18. 3.Imaging Studies: In certain cases, imaging studies may be
ordered to further evaluate the clubfoot. These can include:
● X-rays: X-ray images can help assess the alignment and bony
structures of the foot, including the bones of the ankle, foot
arch, and metatarsals.
● Ultrasound: In infants, an ultrasound may be performed to
evaluate the soft tissues, ligaments, and joint structures of the
foot.
● MRI (Magnetic Resonance Imaging): MRI may be used in
complex cases or to assess associated abnormalities of the
bones, tendons, or nerves.
Diagnostic evaluation

19. X-ray of clubfoot MRI of club foot

21. Management
1. Non-surgical treatment includes manipulating the foot inta a
corrected position and then holding it in position with a cast or
splint with tapes
2. Physiotherapy is always an important part of the treatment. It
may begin once the child is 3 months old. The therapist
manipulates the affected foot and may also tape it.
3. Strething and casting: it is also known as the ponseti method.
The foot is manipulated into a correct position and a cast is
placed to maintain that position
● Repositioning and recasting is repeated for every 1 to 2 week
for 2 to 4 months, each time bringing the foot towards the
normal position

22. 4. The ponseti technique has become the most widely practiced method for initial
treatment of infants born with clubfoot. The corrective process utilising the ponseti
technique can be divided into two phases:
a. The treatment phase : During which the deformity is corrected completely.
● Gentle manipulation and casting is performed on a weekly basis
● Each cast holds the foot in the correct position, allowing it to gradually re shape
b. The maintenance phase: During which a brace is utilized to prevent recurrence
● The final cast remain in place for three weeks, after which the infant foot is placed
into a removable orthotic device.
● The orthosis is worn 23 hours per day for three months and then during the night
time for several years
Management

24. SURGERY
1. Achilles tenotomy : It is a small surgical procedure in which the
Achilles tendon (heel cord) is cut. It allows the ankle to flex upwards
(dorsiflex).
2. Osteotomy: It is a surgical procedure that involves cutting and
reshaping a bone near a damaged joint to minimize stress on the
affected area
3. Fusion and arthrodesis : the orthopedic surgeon manually
straightens out the damaged joint, removes the cartilage, and then
stabilizes the bone so that they heal together.
4. Club foot repair : it is a surgical repair of the birth defect which
involves lengthening or shortening the tendons of the foot

26. Nursing diagnosis: They are as follows:
1. Impaired physical mobility related to
abnormal foot
2. Disturbed body image related to permanent
alternation in structure and /or function
3. Deficient knowledge related to the condition
prognosis treatment self care and discharge
needs
NURSING MANAGEMENT

27. 4. Risk for peripheral neurovascular dysfunction
related to mechanical compression
5. Risk for impaired skin integrity related to cast
application traction or surgery
6. Risk for impaired parenting related to maladaptive
coping strategies secondary to diagnosis of talipes
deformity.
Nursing diagnosis

28. ● Nursing object: Impaired physical mobility
related to abnormal foot
Nursing interventions
1. Assessment and monitoring
2. Educate the patient and family
3. Assistive devices and equipment
4. Pain management
5. Skin care
Nursing management

29. Nursing objective: Disturbed body image related
to permanent alternation in structure and /or
function
Nursing interventions
1. Education and counseling
2. Encourage self-expression
3. Body positivity and acceptance
4. Peer support and social integration
5. Collaboration with other healthcare professionals
6. Family involvement
NURSING MANAGEMENT

30. Nursing objective: Deficient knowledge related to
the condition prognosis treatment self care and
discharge needs
Nursing interventions:
1. Assess learning needs
2. Provide information about clubfoot
3. Teach self-care techniques
4. Facilitate discussions with other families
5. Plan for discharge and follow-up care
NURSING MANAGEMENT

31. Nursing objective: Risk for peripheral neurovascular dysfunction
related to mechanical compression Risk for peripheral
neurovascular dysfunction related to mechanical compression
Nursing interventions:
1. Assess neurovascular status
2. Encourage regular repositioning
3. Monitor footwear and orthotic devices
4. Implement appropriate padding and positioning
5. Monitor for complications
NURSING MANAGEMENT

32. Nursing objective: Risk for impaired skin integrity related to cast
application traction or surgery
Nursing interventions:
1. Regular skin assessments
2. Ensure proper cast/traction application
3. Monitor for pressure points:
4. Maintain skin hygiene:
5. Manage pain and discomfort
6. Regular repositioning and movement
Nursing management

33. 1. Mobility limitations
2. Muscle imbalances and weakness:
3. Joint stiffness
4. Psychosocial impacts
5. Skin breakdown or pressure sores
6. Delayed milestones
Complications

34. 1. Prenatal care
2. Genetic counseling
3. Avoiding risk factors
4. Maintaining a healthy
pregnancy
5. Early detection and treatment
Prevention

35. 1. Definition and causes
2. Prevalence and risk factors:
3. Treatment options
4. Rehabilitation and long-term
care
5. Emotional support
6. Success stories
Health education

36. ● Sharma R., “Essentials of Pediatric
Nursing”, Jaypee publishers, 3rd
edition Pg No. 343-545
Bibliography

37. THANK
YOU