Talipes: Congenital Foot Deformity

Congenital Abnormalities

• Conditions that affect musculoskeletal system

Talipes

• Congenital deformity of foot
• Typically indicated by curled shape or twisted ankle, heel, and toes

Talipes Forms

• Equino: Downward toes
• Calcaneo: Upward heel
• Valgus: Inward
• Varus: Outward
• CTEV, or Clubfoot is the most common type

Talipes Risk Factors

• Being male
• Family history
• Smoking during pregnancy

Talipes Causes

• Idiopathic
• Family history
• Abnormal fetal position and restricted movement in the uterus

Talipes Signs and Symptoms

• Affected foot and/or calf smaller than the other

Talipes Treatments

• Stretching exercise
• Casting
• Splinting

Talipes Post-op Care

• Elevate the affected area
• Encourage toes exercise
• Administer prescribed painkiller
• Observe for any bleeding
• Conduct neurovascular assessment

Talipes Cast Care

• Educate the family or home caregiver
• Passive stretching exercises
• Applying splint and corrective footwear when sleeping

Hip Dysplasia

• Characterized by misalignment of the hip joint
• Includes a ball and socket joint
• Typically affects the left hip
• More common in first-born children

Hip Dysplasia Risk Factors

• Being female
• Family history
• Breech intrauterine presentation
• Postnatal positioning with dangling legs in baby carriers

Hip Dysplasia Clinical Manifestations

• Asymmetrical buttock creases
• Limited abduction
• Shortening of affected leg
• External rotation of affected leg
• Late walking
• Painless limp
• Walking gait like a duck, mainly with bilateral hip joint involvement
• Shorter limb
• Limited abduction and flexion

Hip Dysplasia Investigation Methods

• X-rays
• Anthrograms to obtain x-rays after injecting contrast material into the joint
• Ultrasound

Hip Dysplasia Treatment - Pavlik Harness

• Positions infants hips in flexion, abduction, and external rotation
• Designed to be worn continuously
• Requires consistent skin care to address potential irritation

Hip Dysplasia Treatment - 6 - 8 months

• Gradual reduction through traction
• Open operative reduction if hip non-reducible
• Post-reduction, a hip spica cast may be worn from 2-4 months

Other Hip Dysplasia Treatments

• Hip abduction braces
• Hip Spica Casts (short and long)
• Traction
• Open vs. Closed reduction
• Osteotomy involving surgical reshaping of the bone

Hip Dysplasia Complications

• Osteoarthritis
• Perthes disease that results in necrosis of head of femur

Hereditary Bone Disorders

• Achondroplasia
• Osteogenesis Imperfecta (OI)
• Osteoporosis

Achondroplasia

• Hereditary condition that retards the growth of long bones by ossification of cartilage
• Individuals have very short limbs and sometimes a face is small relative to normal-sized skull

Achondroplasia Clinical Manifestations

• Dwarfism with short, thick long bones, and short extremities
• Relatively large head and trunk with spared cranial and vertebral bone
• Normal intelligence, life span, and reproductive ability

Achondroplasia Complications

• Increased mortality rate
• Spinal stenosis and back pain
• Leg deformities
• Arthritis in the hips and knees
• Obesity and high BMI
• Respiratory and pulmonary disorders
• Abnormal pelvic anatomy and spine deformities

Osteogenesis Imperfecta (OI)

• Characterized by brittle bone disease
• Genetic bone disease
• Defect in production of protein, collagen

Osteogenesis Imperfecta (OI) Clinical Manifestations

• Fragile bones
• Short stature
• Scoliosis - abnormal curvature of the spine
• Bruish sclera
• Laxity of joint ligaments, resulting in hypermobility
• Hearing loss
• Small, fragile, and discolored teeth due to deficiency of dentin
• Thin skin abnormality with easy bruising

Osteogenesis Imperfecta (OI) Management

• Preventing deformities by applying braces and splints
• Preventing fractures
• Engaging in gentle movements
• Taking calcium supplements
• Maintaining a nutritious diet
• Maximizing mobility
• Performing exercises like swimming
• Utilizing mobility aids like canes, walkers, and wheelchairs

Osteogenesis Imperfecta (OI) Complications

• Rare hyperplastic callus formation is mostly managed by conservative, palliative radiotherapy and bisphosphonates
• Tumors such as osteogenic sarcoma
• Basilar invagination with cranial nerve involvement, direct brain stem compression, and altered cerebrospinal fluid dynamics
• Malignant hyperthermia, requiring surgeon and anesthesiologist awareness

Osteoporosis

• Also known as Marble bone Disease
• Marked by defective osteoclast function and abnormal bone overgrowth
• Results in bones becoming thick, dense, and sclerotic

Osteoporosis Characteristics

• Increased size does not improve bone strength
• Leads to multiple fractures with poor healing

Osteoporosis Management

• A diet high in calcium and vitamin D intake to optimize bone mineral density and bone strength
• Weight-bearing exercise like walking and resistance training to improve bone density
• Physical therapy to restore function and strength after fractures
• Bone Medication

Osteoporosis Complications

• Back, hip, or foot pain
• Limping or trouble walking
• Slowed growth
• Decrease in height
• Fracture