Congenital Foot Deformity

　　The causes of congenital malformations include genetic factors, environmental factors, and their interaction. Among them, birth defects caused by genetic factors account for 25%, environmental factors account for 10%, and those caused by the interaction of genetic and environmental factors or unknown causes account for 65%. Congenital malformations caused by genetic factors include chromosomal abnormalities and gene mutations, accounting for 25% of congenital malformations. Chromosomal abnormalities include abnormalities in the number or structure of chromosomes. Chromosomes are normally paired, and a decrease in number can cause congenital malformations, commonly associated with monosomy.

　　Common complications of congenital talipes equinovarus include:

　　1. Skin ulcers: Some degree of skin ulcers will appear in children after plaster fixation treatment, and once the plaster pressure is released, the ulcers can be cured through medication and disinfection measures within one week. No special treatment is required. Generally, no antibiotic treatment is needed.

　　2. Early treatment of equinus may have unsatisfactory corrective effects due to plaster fixation, which is usually related to the doctor's corrective technique and the extent of Achilles tendon release. Insufficient release of the Achilles tendon can lead to deformities such as rocking chair foot, and insufficient abduction can lead to metatarsal adduction deformities. Generally, the plaster is fixed with abduction greater than 75 degrees, and the foot can be naturally abducted before hospitalization for surgical treatment.

　　3. Surgery is for corrective surgery, and recurrence of conditions such as equinus is common. After surgery, the brace should be worn strictly until the age of 4 to minimize the recurrence rate. If there is recurrence of deformities such as metatarsal adduction, visit the clinic in a timely manner for further guidance on treatment.

　　4. Skin necrosis: The use of external fixation frames, soft tissue release surgery, and other surgical methods can cause skin necrosis, which needs to be detected and treated in a timely manner. Local external medication should be applied, and extension should be paused.

　　1. Inverted foot:It is caused by the paralysis of the peroneal longus muscle, causing the foot to bear weight and land on the lateral side during walking and standing, the foot rolls inward, and the Achilles tendon also tilts inward.

　　2. Equinus:Also known as dropped foot or toe foot. It is caused by the paralysis of the anterior tibial muscle. When standing, only the forefoot can be used to land, the ankle joint is excessively plantarflexed, and the heel cannot bear weight and land. The affected foot's Achilles tendon becomes shortened and contracted. Clubfoot and inverted foot often coexist.

　　3. Congenital foot deformity - Clubfoot:It is caused by the paralysis of the anterior tibial muscle, and it is the opposite shape of the inverted foot. It can only land and bear weight on the inner side of the foot, and the inner arch of the foot often sinks.

　　4. Hallux valgus:It is also known as calcaneal foot or calcaneal gait. It is more common in cases of paralysis of the gastrocnemius and soleus muscles and congenital deformities. When standing, walking, and bearing weight, the heel is used to land, the toes are lifted, and the ankle joint is significantly dorsiflexed.

　　5. Arched foot:The longitudinal arch of the foot is significantly higher than normal, and the angle decreases when measuring the arch. There is no discomfort. It is caused by an imbalance in the force on the intrinsic and extrinsic muscles of the foot.

　　6. Hammer toe:It is caused by excessive relaxation of the transverse arch of the foot.

　　7. Flatfoot:Flatfoot refers to the disappearance of the arch of the foot. The arch of the foot is composed of bones, ligaments, and muscles, and normally has transverse and longitudinal arches. The small bones of the human foot are stacked together to form an arch. When a person stands, walks, and bears weight, not all of the weight is on the foot, with the metatarsal bones and heel mainly bearing the weight. The arch is often suspended to cushion the shock, protect the brain and internal organs, and give people good elasticity. If the structure of the arch is underdeveloped or due to various injuries, the disappearance of the arch forms flatfoot. Some have a hereditary component. Some flatfoot does not cause discomfort, while others may experience pain, affecting walking.

　　In addition, various外伤 caused by foot scar contracture can also lead to foot deformity.

　　This disease focuses on prevention, and early detection, early diagnosis, and early treatment are of great significance for the indirect prevention of the disease. At the same time, genetic counseling should be carried out. During pregnancy, attention should be paid to strengthening the dietary nutrition of pregnant women, especially the intake of protein and trace elements, and regular ultrasound examinations should be carried out to clarify the situation. Pay attention to the posture of pregnant women during pregnancy to avoid pressure causing deformity.

　　1. X-ray examination:For the objective evaluation of the degree of clubfoot deformity and the therapeutic efficacy. The anteroposterior and extreme dorsiflexion lateral radiographs of the feet are compared bilaterally. The anteroposterior radiograph of the clubfoot child shows: the talus overlaps the navicular bone, and both are directed towards the fifth metatarsal, and the talus-navicular angle disappears.

　　2. Ultrasound examination:It is a routine examination used to diagnose infantile clubfoot, which has an irreplaceable role in observing the condition of cartilage that X-ray films cannot replace.

　　3. MRI and CT:Scans are also recommended for preoperative and postoperative evaluation of congenital equine foot deformities, but most children do not need to undergo these examinations.

　　It is best to supplement calcium through diet for congenital foot deformities:

　　1. Milk and dairy products: Cows, sheep, horse milk and its milk powder, cheese, yogurt, condensed milk, ice cream. 500 milliliters of fresh milk can supplement 600 milligrams of calcium.

　　2. Fish, shrimp, crab, and marine products:Crucian carp, carp, silver carp, eel, shrimp, dried shrimp, shrimp paste, crab, kelp, seaweed, clam, sea cucumber,螺蛳, etc.

　　3. Meat and poultry eggs:Lamb, pork brain, chicken, eggs, duck eggs, quail eggs, preserved eggs, pork flake, etc.

　　4. Beans and bean products:Soybean, soybean sprouts, broad bean, lentil, tofu, tofu skin, tofu curd, etc. (100 grams of tofu can supplement 200 milligrams of calcium).

　　5. Vegetables:Celery, rapeseed, carrot, radish leaves, sesame, coriander, rapeseed, black fungus, mushrooms, etc.

　　6. Fruits and dried fruits:Including lemon, loquat, apple, jujube,杏脯, orange cake, peach cake, almond, hawthorn, dried grapes, walnut, watermelon seeds, pumpkin seeds, dried mulberry, peanuts, lotus seeds, and chestnuts, etc.

　　1. Early treatment

　　Non-surgical treatment plan

　　1. Ponseti orthopedic method:The specific treatment method has been recognized worldwide, as follows (for children under 2 years of age):

　　Manual manipulation and plaster cast correction (Ponseti plaster cast): Suitable for children under 1 year old, the components of the deformity are corrected step by step according to a certain program, and then fixed with a plaster cast (usually fixed 4-6 times in the outpatient department).

　　When the plaster cast reaches more than 75 degrees of external abduction of the foot, the Achilles tenotomy surgery can be performed. After the operation, the plaster cast is fixed for 3 weeks, and the cast is removed after 3 weeks, and the orthopedic shoes are changed at the same time.

　　Wear the Dennis-Brown orthotic shoe for further treatment after surgery, usually until the age of 4.

　　2. French Massage Technique:Newborns should receive immediate manual treatment, with the knee flexed to 90 degrees during operation, one hand holding the heel, and the other hand pushing the anterior half of the foot outward to correct the adduction of the forefoot, then holding the heel to perform eversion, and finally using the palm to drag the sole to perform extension to correct the talipes. Multiple manual corrections should be performed daily until the deformity is corrected.

　　Second, Surgical Treatment

　　However, for children who have missed the opportunity for non-surgical correction or who have had recurrence of deformity after correction due to not wearing the orthotic brace as instructed by the doctor, corresponding symptomatic surgical treatment should be performed according to their different conditions.

　　1. Extensive soft tissue release surgery:The general principles of any stage of extensive release treatment for talipes equinovarus include:

　　(1) After the operation is completed, release the tourniquet and coagulate the bleeding;

　　(2) If necessary, keep the foot in a plantar flexed position, carefully suture the subcutaneous tissue and skin to avoid excessive skin tension;

　　(3) When changing the cast for the first time after 2 weeks of surgery, the foot can be placed in a fully corrected position.

　　2. Achilles Tenotomy:For children who have missed the age for Achilles tenotomy surgery (usually 2-3 years old), the Achilles tenotomy needs to be performed to make the calcaneus fall, and the Achilles tenotomy needs to be performed to perform a Z-shaped incision on the Achilles tendon. The cast is fixed for 6 weeks after surgery.

　　3. Proximal Tibialis Muscle Transposition:Applicable to children with early mild recurrence of talipes equinovarus or residual forefoot adduction deformity after treatment.

　　4. External Fixation Frame:For older rigid talipes varus children (usually over 5 years old), the foot bones have ossified, and the deformity cannot be corrected simply through soft tissue. The external fixation frame technology can be used, and the frame needs to be adjusted regularly after surgery. The appearance is basically satisfactory, but there will be residual stiffness of the foot and ankle joints.

　　5. Foot Osteotomy Correction:There are many surgical methods, generally for children over 5 years old, the choice of osteotomy at different parts is based on the degree of deformity, and it can be combined with external fixation frame to correct the deformity of talipes varus.

　　6. Triple Arthrodesis:Indications: Children over 10 years old; with three deformities of metatarsal adduction, hindfoot varus, and plantar flexion; this operation can be considered.