Congenital clubfoot, also called congenital talipes equinovarus (CTEV), is one of the most common deformity of the musculoskeletal system. It is estimated that in Europe it affects about 1-3/1000 children, occurring 2-3 times more frequently in boys than girls. The cause of this defect is not fully known yet. It is believed that the main factor is the damage, such as incorrect positioning of the fetus in the uterus or the genetic predisposition, which can disturb the functioning of the spinal cord in its lower section, thus causing the uneven tension of the muscles in the distal sections of the lower limbs and leading to the tissue fibrosis in this area. This results in the displacement of the bone and the clubfoot varus foot setting, which is characterized by the plantar flexion of the foot, and the varus, the foot inversion, when the foot rolls outwards (also called supination) and, additionally, the adduction of the forefoot.
These changes are also accompanied by a hollow of the longitudinal foot arch and hammer-toes (or contracted toes ), followed by a reduction and shortening of the foot, shortening of the lower leg, hyperextension of the knee joint and damage to the peroneal nerve, as well as the contracture of the Achilles tendon, the posterior muscle of the tibialis, and the flexor and abduction muscles of the foot. These changes cause a gait disorder (stilt-like gait) which lacks the natural bounce. The main deformation in this defect occurs within the tarsal bones, the positions of which are unnatural and forced. The talus bone of the clubfoot is set in plantar flexion, the navicular is medially displaced while the heel is adducted and inversed. This defect most commonly occurs bilaterally, but it can also occur on one side only or coexist with other defects.
Congenital clubfoot is one of several clinical forms:
- habitual form, also known as postural - the deformation of the foot is the least severe, it has the normal size and slim shape and it is correctable by the passive correction process;
- idiopathic form - the foot is smaller than the in the previous form one and is not fully correctable in the process of passive correction;
- short, wide and stiff foot - this foot is short and wide, it is characterized by the visible clubfoot position of the foot, and it is correctable only to a little extent.
Depending on the degree of clubfoot correction ability , the four types are distinguished:
- Type I: soft-soft, in which the foot is correctable,
- Type II soft-rigid,
- Type III: rigid-soft,
- Type IV: rigid - rigid.
One of the alternatives used in the treatment of clubfoot is the Ponseti method, based on stretching the constricted muscles and immobilizing the foot in the correct direction (extension and using cast). After obtaining a correction and completion of treatment, a brace shall be applied in the cast. Understanding and using cast and a sequence of alignment and proper technique of the bandages is crucial.