Congenital Clubfoot

　　The true cause of congenital clubfoot varus is not yet clear. Most scholars believe that this deformity is caused by developmental abnormalities due to the influence of internal and external factors in the early embryonic stage, and it is also commonly related to the incorrect position of the fetus's foot in the uterus. Possible pathogenic factors are as follows:

　　1. Genetic factors

　　This disease often has a family history and is related to heredity to some extent. For example, Wynne-Pavis et al. reported that the proportion of patients with a family history is 2.9%. Additionally, the incidence of monozygotic twins is much higher than that of dizygotic twins, with a ratio of 33:3. Although heredity is an important factor, the dominant, recessive, or sex-linked gene inheritance pattern has not yet been determined.

　　2. Embryonic factors

　　Within the first 3 months of the embryo, the foot is in three primitive deformities of clubfoot varus, namely, downward, internal adduction, and supination. Starting from the fourth month, the foot is in a neutral and rotational position, with the metatarsals slightly adducted, and the foot also begins to rotate forward along the long axis, approaching the position of a normal foot. Any developmental disorder will cause the foot to remain in the deformed position of the early embryonic stage.

　　3. Intrauterine factors

　　The fetus is in an unfavorable position in the uterus, with the foot compressed, long-term internal adduction, talus inversion, and downward position of the ankle. Consequently, the muscles on the posterior and medial sides of the lower leg become shortened, and the medial joint capsule thickens, further causing the foot to be in an abnormal position.

　　4. Environmental factors

　　Many scholars have found that the disease is related to environmental factors, such as Duraswami injecting insulin into the developing chick embryo, causing talipes equinovarus deformity. Some people have proven that at the key moment of limb development, hypoxia can lead to talipes equinovarus. Stewart found that in many patients from Japan, due to the habit of sitting on the inverted foot, the incidence rate is particularly high.

　　Congenital talipes equinovarus is a congenital disease, and the following is a specific introduction to the complications of congenital talipes equinovarus.

　　Firstly, after long-term loading, the top of the foot side appears thickened bursae and calluses, and a few cases develop ulcers.

　　Secondly, the main manifestations of postoperative complications in children are as follows:

　　1. Postoperative pain: For children who are completely conscious after surgery, the reaction of the cerebral cortex to pain is affected by the psychological state, so tension, anxiety, and fear all reduce the pain threshold.

　　2. Bedsores: Due to long-term bed rest and lack of exercise, congenital talipes equinovarus children have poor blood circulation in various parts of the limbs, and the compressed parts are prone to bedsores.

　　3. Limb ischemic necrosis or muscle contracture: The initial manifestations are mainly pale color of the affected limb, reduced temperature, dull skin sensation, inability to move independently, or local persistent pain. At this time, the石膏绷带 should be opened to prevent limb ischemic necrosis or muscle contracture.

　　Congenital talipes equinovarus shows different degrees of inversion and下垂 deformity on one or both feet after birth. The specific manifestations are as follows:

　　1. The foot of the baby is in a talipes equinovarus deformity after birth. The newborn's tissues are soft, and most or all deformities can be corrected by hand, but the deformity reappears after releasing the hand. A few children are born with stiff feet and bone changes, which are difficult to correct.

　　2. The action of flexion and inversion of the affected foot is easy and strong, while the extension and eversion is difficult.

　　3. The talus bone can be felt on the top of the foot, the inner side of the foot is concave, the outer side is convex, the whole foot is in a plantar flexed position, and the front part of the foot is adducted.

　　4. The child has difficulty standing, delayed walking, marked limping, stiffness of soft tissue and joints, which cannot be corrected by hand. The feet are small, the calves are thin, and muscle atrophy is obvious, but the sensation is normal.

　　5. The lateral aspect of the foot forms a callus. After 5-6 years old, it forms a rigid fixed deformity, bone deformation, and difficult walking.

　　6. There is often a rotational deformity in the lower part of the calf.

　　Congenital talipes equinovarus is a congenital disease with no effective preventive measures. Early diagnosis and treatment are the key to the prevention and treatment of the disease. At the same time, attention should be paid to functional exercise for children with the disease. Functional exercise is a very important link for children with congenital talipes equinovarus after discharge. Reasonable and active functional exercise can help the child's affected limb quickly recover to normal level, but early children are unwilling or afraid to move, so it is necessary to explain the importance of functional exercise to the parents of the children, fully mobilize the enthusiasm of the parents or accompanying family members, and cooperate with necessary passive exercises to effectively reduce postoperative complications, and adopt a step-by-step approach.

　　There are no related laboratory tests for congenital clubfoot. This disease can be diagnosed based on clinical manifestations, and generally does not need to be confirmed by X-ray examination. However, for judging the degree of clubfoot deformity and objectively evaluating the efficacy of treatment, X-ray photography is indispensable. The X-ray film of a normal newborn's foot can see the ossification centers of the calcaneus, talus, and cuneiform bones. The ossification centers of the bones in the child with clubfoot varus appear later, the navicular bone appears after 3 years, and the metatarsal shafts ossify well after birth.

　　1. Frontal view

　　The longitudinal axis of the normal talus has an angle of about 30° with the longitudinal axis of the calcaneus. If it is less than 20°, it indicates the varus of the posterior part of the foot. The first metatarsal bone of the normal foot is parallel or crosses the longitudinal axis of the talus, and the fifth metatarsal bone is parallel or crosses the longitudinal axis of the calcaneus. When the angle is greater than 20°, it indicates the adduction of the anterior part of the foot.

　　2. Lateral view

　　The longitudinal axis of the normal talus is parallel to the first metatarsal bone, while in patients with clubfoot varus, the two intersect to form an angle.

　　The diet of congenital clubfoot patients should be light and easy to digest, with a high intake of vegetables and fruits, a reasonable diet, and attention to adequate nutrition. In addition, patients should also pay attention to avoid spicy, greasy, and cold foods.

　　Traditional Chinese Medicine manual therapy can alleviate the symptoms of congenital clubfoot, which should generally be massaged and corrected in several directions by the parents under the guidance of a doctor for the baby's affected foot, preferably during feeding and without restricting the lower limb movement and kicking of the baby. After the baby gets accustomed and calm, formal manual operations can be carried out.

　　Operation Technique: The operator holds the lower segment of the child's lower leg and ankle joint with the left hand to protect the epiphysis of the joint, bends the knee to 90 degrees, and performs the technique in order day by day. Generally, the deformity of the forefoot adduction and the subtalar joint varus is corrected first, and after several weeks, the deformity of the ankle plantar flexion and supination is corrected. When correcting foot drop, the heel should be pulled down to make the ankle dorsiflexion, and it is strictly forbidden to force the forefoot to dorsiflexion. During the process of correcting various deformities in the opposite direction, the soft tissue on the outer edge of the foot should be massaged. During and after the manual correction, the corresponding brace should be used to fix the foot and encourage the child to perform active foot eversion exercises.