a group of congenital birth defect Oligohydramnios is a condition that can develop during pregnancy. It occurs when not enough amniotic fluid, which surrounds the fetus, is produced. Oligohydramnios sequence is the pattern of abnormalities that results.
Congential Talipes equinovarus: it`s a common form of clubfoot.
Talipes = talus (ankle) + pes (foot).
Equino = heel is elevated (like a horse's)
varus = turned inward.
With this type of clubfoot, the foot is turned in sharply and the person
seems to be walkingon their ankle.
Clubfoot is a condition in which one or both feet are twisted into an
abnormal position at birth.
Common birth defect
Other terms Giles Smith Syndrome, congenital talipes aquinovarus
The condition is also known as talipes. It is a general term used to
describe a range of unusual positions of the foot.
Present at birth and affects the foot and/or ankle.
There is no known cause for clubfoot
Most common in male children as it is in female children.
Most type of clubfoot is present at birth which can happen in one foot
or in both feet. In almost half of affected infants, both feet are
involved. Although clubfoot is painless in a baby,
Approximately 50% cases of clubfoot are bilateral
Family history of clubfoot.
Smoking during pregnency
Position of the baby in the uterus.
Increased occurrences in those children with neuromuscular disorders,
such as cerebral palsy and spina bifida.
Amniotic Band Syndrome
Seek a detailed family history of clubfoot or neuromuscular disorders, and perform
a general examination to identify any other abnormalities. Examine the feet with
the child prone, with the plantar aspect of the feet visualized, and supine to
evaluate internal rotation and varus. If the child can stand, determine whether the
foot is plantigrade, whether the heel is bearing weight, and whether it is in varus,
valgus, or neutral.
Similar deformities are seen with myelomeningocele and arthrogryposis.
Therefore, always examine for these associated conditions. The ankle is in equinus,
and the foot is supinated (varus) and adducted (a normal infant foot usually can be
dorsiflexed and everted, so that the foot touches the anterior tibia). Dorsiflexion
beyond 90° is not possible.
The navicular is displaced medially, as is the cuboid. Contractures of
the medial plantar soft tissues are present. Not only is the calcaneus in
a position of equinus, but also the anterior aspect is rotated medially
and the posterior aspect laterally.
The heel is small and empty. The heel feels soft to the touch (akin to
the feel of the cheeks). As the treatment progresses, it fills in and
develops a firmer feel (akin to the feel of the nose or of the chin).
The talar neck is easily palpable in the sinus tarsi as it is uncovered laterally.
Normally, this is covered by the navicular, and the talar body is in the mortise. The
medial malleolus is difficult to palpate and is often in contact with the navicular.
The normal navicular-malleolar interval is diminished.
Clubfoot is painless in a baby, but it can eventually cause discomfort and become a
Left untreated, clubfoot does not straighten itself out.
The foot will remain twisted out of shape, and the affected leg may be shorter and smaller
than the other.
These symptoms become more obvious and more of a problem as the child grows.
There are also problems with fitting shoes and participating in normal play. Treatment that
begins shortly after birth can help overcome these problems.
1. Metatarsus Adducts :- Metatarsus adducts is common in newborns
and involves adduction of the forefoot relative to the hindfoot..
Clinical picture of
metatarsus adductus with a
normal foot on opposite
Congenital Vertical Talus
It is an uncommon foot deformity
in which the midfoot is dorsally
dislocated on the hindfoot. While
approximately 60% of cases are
idiopathic, 40% are associated with
an underlying neuromuscular
condition or a syndrome. Neurologic
causes include myelodysplasia,
tethered cord, and sacral agenesis.
It is a common finding in the
newborn and is secondary to
in utero positioning. Excessive
dorsiflexion and eversion are
observed in the hindfoot, and
the forefoot may be abducted.
There may be an associated
external tibial torsion.
Cavus is a deformity involving plantarflexion of
the forefoot or midfoot on the hindfoot and may
involve the entire forepart of the foot or just the
medial column. The result is an elevation of the
longitudinal arch , and a deformity of the
hindfoot will often develop to compensate for
the primary forefoot abnormality.
Stretching and casting (Ponseti Method)
Stretching and taping (French Method)
The most difficult deformity to correct is the hindfoot equinus, and
approximately 90% of patients will require a percutaneous tenotomy
of the heel cord as an outpatient.
Following the tenotomy, a long leg cast with the foot in maximal
abduction (70 degrees) and dorsiflexion is worn for 3 week the
patient then begins a bracing program.
REFERENCE :-nelson book of pediatrics 18th edition