The clubfoot is either congenital, which unfortunately is not uncommon, or acquired due to disturbances in the nerve supply. About 1-3 children out of 1,000 newborns are born with a clubfoot. Boys are affected about twice as often and in 40% of the cases not only one foot is affected but both feet. The signs are unmistakable: The forefoot is turned strongly inward (=sickle foot), the longitudinal arch is elevated (= hollow foot) and the heel is raised and points inward (=varus position). In addition, affected persons have a so-called club foot: the calf muscles are bent and the Achilles tendon is very thin and shortened.
Causes
The causes are manifold and not all are known yet. Doctors distinguish between congenital and acquired clubfoot. Various factors play a role in congenital clubfoot, especially genetic influences.
Another explanation is that the development of the foot during pregnancy has stopped at a developmental stage or has been disturbed, for example, if the mother smoked during pregnancy or is suffering from a viral infection. A clubfoot can also be caused by a positional anomaly, for example if the growth of the legs and feet is restricted when the child is placed transversely. If there has been a lack of amniotic fluid for a long time or if the child suffers brain damage in early childhood, a clubfoot often develops. Acquired clubfoot is rare and usually occurs due to an injury to the lower leg, poliomyelitis (= polio) or neurological diseases such as myelomeningocele (= malformation of the spinal cord). A circulatory disorder of the calf muscle artery can also cause clubfoot.
Treatment/exercises
A clubfoot is a complex foot malposition that must be treated as soon as possible. Physiotherapy plays a decisive role in the treatment process – it must be carried out continuously until growth is complete. Otherwise, there is a risk that the clubfoot will return to its original malposition.
The main goal of physiotherapy is to counteract the foot malposition to such an extent that the child can learn to walk with straight feet or those affected can move their foot freely and painlessly. Physiotherapy for children usually follows the treatment concepts of Vojta or Bobath. Otherwise, it is based on the functional, three-dimensional foot therapy according to Zukunft-Huber.
Here, the clubfoot is corrected in four treatment phases. In each phase, a different part of the deformity is stretched with special correction grips and thus corrected. For small children it is important that the parents are involved in the treatment process.
They are instructed by the physiotherapist so that they can perform suitable exercises independently with their child. In the further course of the treatment, the physiotherapist stretches the shortened muscles, mobilizes the tarsal joints, complements psychomotor exercises on the therapy spinning top and wiggle board and does exercises with the affected child that counteract the clubfoot and strengthen the weakened muscles: 1) Stretching of the calf muscles and Achilles tendon: The patient takes a step position and supports himself with both hands against a wall. The feet point as far forward as possible.
The body weight is shifted to the front, healthy leg and the knee is slightly bent. The back leg is stretched out. The heel of the clubfoot is pressed down as far as possible.
Hold the stretch for 10 seconds. 2.) Strengthening the calf and foot muscles: The patient lies in a supine position and puts his legs at a 90 degree angle.
Now the patient lifts the buttocks until pelvis and knees are at about the same level. Then additionally lift the heels. Hold position briefly.
Repeat 10 times. 3.) Correction of the inner rotation of the clubfoot: The therapist fixes a Theraband from the side around the outer edge of the clubfoot.
The Theraband now pulls the clubfoot even more inwards. The patient should now actively move his foot outwards. Compensatory movements with knee or hip movements are not allowed. In addition, tape bandages can be applied.
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