Congenital Diagnosis 2
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| Define clubfoot (talipes equinovarus). | Deformity present at birth consisting of forefoot adduction, hindfoot varus and ankle equines (fixed plantarflexion). | |
| What is the etiology of clubfoot (talipes equinovarus)? | Isolated deformity, positional related to neurological disorders, in association with syndromes, possible genetic predisposition. | |
| What joints are malaligned in clubfoot (talipes equinovarus)? | Talocalcaneal, talonavicular, calcaneocuboid. | |
| What are the soft tissue problems in clubfoot (talipes equinovarus)? | Structures are shortened medially and lengthened laterally. | |
| What is the conservative management for clubfoot (talipes equinovarus)? | Manipulation, serial casting, splinting, taping, and stretching. | |
| What is the recommended order for correction of clubfoot (talipes equinovarus)? | Forefoot adduction, hindfoot varus, and ankle equines. | |
| What is the surgical management for clubfoot (talipes equinovarus)? | Tendon and ligament lengthening on posterior and medial aspects of foot, tendon transfers, capsulotomies, adjustment of lateral ligaments. | |
| What is the therapy for clubfoot (talipes equinovarus)? | Stretching/scar massage, splinting, taping, monitoring casts, education, sensory experiences, strengthening, and gait training. | |
| Define torticollis (wry neck). | Asymmetrical posturing of the head and neck, laterally flexed toward the shortened muscle and rotated toward the opposite side, facial asymmetry and plagiocephaly may occur, 75% is on right side. | |
| What is the etiology of torticollis? | C-sections or difficult delivery, congenital hip dislocation, foot deformities, intrauterine position incidence higher in boys. | |
| What are the implications of an affected R SCM? | Head positioned in lateral flexion to R and rotation to L, motion limited in lateral flexion to L and rotation to R. | |
| What are the implications of an affected L SCM? | Head positioned in lateral flexion to L and rotation to R, motion limited in lateral flexion to R and rotation to L. | |
| How is torticollis diagnosed? | Radiographs to rule out cervical spine problems. | |
| What is the conservative management for torticollis? | Active and passive stretching for the SCM and upper trapezius, active ROM, strengthening for contralateral muscle, education for the parent. | |
| What is the surgical management for torticollis? | Release of muscle distally at one or both heads. |
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