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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