Congenital Foot Deformity

　　．Οι αιτίες της γεννήσιμης δυσπλασίας περιλαμβάνουν την γενετική αιτία, τους περιβαλλοντικούς παράγοντες και την αλληλεπίδρασή τους, μεταξύ των οποίων η γενετική αιτία προκαλεί το % των γεννήσιμων δυσπλασιών.25．Οι περιβαλλοντικοί παράγοντες αντιπροσωπεύουν το %.10．Η γενετική αιτία σε συνδυασμό με περιβαλλοντικούς παράγοντες και αιτίες που δεν είναι γνωστές αντιπροσωπεύουν το %.65．Η γενετική αιτία προκαλεί την παραμορφωτική γεννήσιμη δυσπλασία, συμπεριλαμβανομένων των αλλοιώσεων των χρωμοσωμάτων και των μεταβολών των γονιδίων, που αντιπροσωπεύουν το % της γεννήσιμης δυσπλασίας.25％, chromosomal abnormalities include abnormalities in the number or structure of chromosomes. Chromosomes are naturally paired, and a decrease in number can cause congenital deformities, commonly associated with monosomy.

　　Common complications of congenital talipes equinovarus include:

　　1Skin pressure sores: After plaster fixation treatment, some children will inevitably have skin pressure sores, and once the plaster pressure is released, the pressure sores can be treated through measures such as changing dressings and disinfection1weeks of time to heal. No special treatment is required. Generally, no antibiotic treatment is needed.

　　2Early treatment of clubfoot may have unsatisfactory orthopedic effects due to plaster fixation, which is usually related to the doctor's orthopedic technique and the degree of Achilles tendon release. Inadequate release of the Achilles tendon may result in deformities such as swing foot, and insufficient abduction may result in deformities such as metatarsal adduction. Generally, the abduction after plaster fixation75degrees, only when the foot is naturally abducted can the patient be admitted for surgical treatment.

　　3Surgery is for orthopedic surgery, and there may be recurrences such as clubfoot, and it is necessary to wear supports strictly after surgery4years, to minimize the recurrence rate. Once symptoms of deformity recurrence such as metatarsal adduction appear, seek medical attention in the outpatient department in time and guide further treatment.

　　4Skin necrosis: Skin necrosis can be caused by surgical methods such as external fixation frames and soft tissue release, and needs to be detected and treated in time, with local external medication and suspension of extension.

　　1Inward foot:caused by the paralysis of the longus muscle of the fibula, can only bear weight and land on the lateral side of the foot when walking and standing, the foot rolls inward, and the Achilles tendon also tilts inward.

　　2Clubfoot:Also known as dropped foot, pointed foot. Caused by the paralysis of the anterior tibial muscle. When standing, only the front part of the foot can touch the ground, the ankle joint is excessively plantar flexed, and the heel cannot bear weight on the ground. The affected heel tendons become short and contracted. Clubfoot and talipes equinovarus often coexist.

　　3Congenital talipes exavum:caused by the paralysis of the anterior tibial muscle, the opposite shape of the inward foot, can only land and bear weight on the inner side of the foot, and the inner foot arch often sinks.

　　4Supinated foot:Also known as heel foot, heel walking foot. It is common in cases of paralysis of the gastrocnemius and plantaris muscles and congenital deformities. When standing, walking, and bearing weight, the heel touches the ground, the toes are raised, and the ankle joint is hyperextended.

　　5Arched foot:The longitudinal arch of the foot is significantly higher than normal, and the angle is reduced when measuring the arch. There is no discomfort. It is caused by unbalanced force between the intrinsic and extrinsic muscles of the foot.

　　6Hammer toe:due to excessive relaxation of the transverse arch of the foot.

　　7Flat foot:The flat foot refers to the disappearance of the arch. The arch is formed by the bones of the foot, tendons, and muscles, and normally has transverse and longitudinal arches. The small bones of the human foot are piled up to form an arch. When the human body stands, walks, and bears weight, the foot is not fully burdened, with the metatarsal bones and heel mainly bearing the weight. The arch often hangs in the air to cushion shocks, protect the brain and internal organs, and make people have good elasticity. If the structure of the arch develops abnormally or due to various injuries, the disappearance of the arch forms flat feet. Some are hereditary. Some flat feet have no discomfort, while some may experience pain, affecting walking.

　　此外，各种外伤造成足部瘢痕挛缩也可导致足部变形。

　　本病在于预防为主，注意早期发现、早期诊断、早期治疗对间接预防本病具有重要意义，同时应进行遗传咨询。孕期需要注意加强孕妇的饮食营养情况，尤其是需要注意蛋白质和微量元素的摄入量，注意定期B超检查明确情况。怀孕期间注意孕妇的姿势，避免压迫导致畸形的情况。

　　1、X线检查：对于诊断马蹄内翻足畸形程度和治疗疗效的客观评价。足前后位和极度背伸侧位片，双侧足部进行对比，马蹄足患儿的正位片示：跟骨距骨重叠，且均朝向第五跖骨，跟距角度消失。

　　2、B超检查：是可以用来诊断婴幼儿马蹄足的常规检查，对于观察软骨的情况具有X光片无法替代的作用。

　　3、MRI和CT：扫描也被推荐用于先天性马蹄内翻足畸形的术前及术后评估，但大多数患儿没有必要进行这些检查。

　　先天性足畸形饮食补充钙质为佳：

　　1、乳类与乳制品：牛、羊、马奶及其奶粉、乳酪、酸奶、炼乳、冰激凌。500毫升鲜牛奶可补充600毫克钙。

　　2、鱼虾蟹类与海产品：鲫鱼、鲤鱼、鲢鱼、泥鳅、虾、虾米、虾皮、螃蟹、海带、紫菜、蛤蜊、海参、田螺等。

　　3、肉类与禽蛋：羊肉、猪脑、鸡肉、鸡蛋、鸭蛋、鹌鹑蛋、松花蛋、猪肉松等。

　　4、豆类与豆制品：黄豆、毛豆、扁豆、蚕豆、豆腐、豆腐干(100克豆腐于可补充200毫克钙)、豆腐皮、豆腐乳等。

　　5、蔬菜类：芹菜、油菜、胡萝卜、萝卜缨、芝麻、香菜、雪里蕻、黑木耳、蘑菇等。

　　6、水果与干果类：柠檬、枇杷、苹果、黑枣、杏脯、桔饼、桃脯、杏仁、山楂、葡萄干、胡桃、西瓜子、南瓜子、桑椹干、花生、莲子、芡实等。

　　1. Πρώιμη θεραπεία

　　Μέθοδος μη χειρουργικής θεραπείας

　　1και η μέθοδος Ponseti:Παραδοσιακά έχει λάβει την αναγνώριση του κόσμου, και η συγκεκριμένη μέθοδος θεραπείας είναι η εξής (εφαρμόζεται σε παιδιά κάτω από την ηλικία των2Παιδιά της ηλικίας των

　　Τεχνική扳正, γυάλιστη τοποθέτηση (Ponseti γυάλιστη τοποθέτηση): Εφαρμόζεται1Παιδιά κάτω από τα 4 χρόνια, πρέπει να διορθώσουν τα τμήματα της δυσμορφίας με μια συγκεκριμένη διαδικασία και στη συνέχεια να τοποθετήσουν γυάλιστη τοποθέτηση (γενικά η τοποθέτηση στο γραφείο)4-6)).

　　Η γυάλιστη τοποθέτηση πρέπει να φτάσει στην εξωτερική εκτόνωση του ποδιού75Πάνω από την ποιότητα, μπορεί να γίνει χειρουργική αποκατάσταση της αρθρικής αλυσοδέσης, και να γίνει η γυάλιστη τοποθέτηση μετά το χειρουργείο3weeks,3weeks after the plaster is removed, and the orthotic shoes are changed.

　　After surgery, wear Dennis-Brown orthotic shoes for further treatment, usually to4years old.

　　2、French Massage Technique:Newborns should be treated by hand immediately, during the operation, the knee should be flexed90 degrees, one hand holding the heel, the other hand pushing the anterior half of the foot outward to correct the adduction of the forefoot, then holding the heel to perform varus, finally, with the palm supporting the sole to perform extension, correct the clubfoot, correct the deformity multiple times a day until the deformity is corrected.

　　Second, Surgical Treatment

　　However, for children who missed the opportunity for non-surgical correction or for children whose deformities recur 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 clubfoot include:

　　（1）When the operation is completed, release the tourniquet and coagulate the bleeding with electricity;

　　（2）If necessary, keep the foot in plantar flexion position, carefully suture the subcutaneous tissue and skin, so as not to cause excessive skin tension;

　　（3）After surgery2when changing the plaster for the first time, the foot can be placed in a completely corrected position.

　　2、Achilles Tendon Lengthening Surgery:For children who missed the age of Achilles tendon release surgery (usually2-3years old) need to relax the Achilles tendon, so that the talus falls, need to perform Achilles tendon lengthening surgery, perform Z-shaped incision on the Achilles tendon. Postoperative plaster fixation6weeks.

　　3、Tibialis Anterior Transfer:is suitable for children with early mild recurrence of clubfoot or residual forefoot adduction deformity after treatment.

　　4、External Fixation Frame:For older rigid clubfoot children (usually5years old), the foot bones have ossified, it is impossible to correct the deformity simply through soft tissue, external fixation frame technology can be used, regular adjustment of the frame after surgery, the appearance is basically satisfactory, but there will be foot and ankle joint stiffness.

　　5、Foot Osteotomy Correction:There are many surgical methods, generally children over5years old, according to their deformity, choose different parts of osteotomy, can be combined with external fixation frame to correct the clubfoot varus deformity.

　　6、Tricompartmental Osteotomy:Indications:10Children over the age of; with three deformities of metatarsal adduction, posterior foot varus, and plantar flexion; this operation can be considered.