General Practice 2022

Pé torto congênito: what é, how to identify and treatment

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Pé torto congênito: what é, how to identify and treatment
Pé torto congênito: what é, how to identify and treatment
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Congenital clubfoot, also known as equinovarus congenital clubfoot or, popularly, as "inward clubfoot", is a congenital malformation in which the baby is born with one foot or both feet turned inwards..

This alteration can be identified even during pregnancy, through an ultrasound exam, but it is only confirmed after birth by observing the position of the feet, without the need to perform any other exam to confirm the diagnosis.

Congenital clubfoot is curable as long as the treatment is carried out according to the pediatrician and orthopedist's guidance, and the Ponseti method may be indicated, which consists of the use of plaster and orthopedic boots, or surgery to correct the position of the feet, however surgery is only indicated when other treatment methods are ineffective.

How to identify

The identification of congenital clubfoot can be carried out even during pregnancy by means of ultrasound, and the change in the position of the feet can be visualized by this exam. However, confirmation of congenital clubfoot is only possible after birth through a physical examination, and no other imaging exam is necessary, in which the following can be observed:

  • Feet facing down;
  • Front of feet facing inward, toward opposite leg;
  • Thinner calf;
  • Feet smaller than normal for age.

After confirmation of congenital clubfoot, the doctor may recommend performing other tests in order to identify the possible cause, since it may be associated with genetic or neuromuscular alterations, or be just a postural alteration, improving over time.In this way, it is possible to start the most appropriate treatment.

Possible causes

The causes of clubfoot are still unknown and widely discussed, however some researchers believe that this condition is essentially genetic and that throughout the baby's development there was activation of genes responsible for this deformity.

Another theory also accepted and discussed is that cells capable of contracting and stimulating growth may be present on the inside of the leg and foot and that, when contracting, they directed the growth and development of the feet inwards..

Although there are several theories about the occurrence of clubfoot, it is important that treatment is started early to ensure the child's quality of life.

Treatment for congenital clubfoot

It is possible to correct clubfeet as long as treatment is started quickly. The ideal age to start treatment is controversial, being recommended by some orthopedists that treatment should be started soon after birth, and by others that it should be started only when the baby is 9 months old or when he is about 80 cm tall.

Treatment can be done through manipulation, which corresponds to conservative treatment, or surgery, which is only indicated when the first method is not effective.

Conservative treatment

The main method of manipulations for clubfoot treatment is known as the Ponseti method, which involves manipulation of the child's legs by the orthopedic doctor and placing a plaster cast every week for about 5 months to correctly align the legs. foot bones and tendons.

After this period, the child should wear orthopedic boots 23 hours a day for 3 months and at night until they are 3 or 4 years old, to prevent the foot from bending again. When the Ponseti method is performed correctly, the child can walk and develop normally.

However, in cases where the Ponseti method is not effective, surgery may be indicated, which must be performed before the child is 1 year old.In this surgery, the feet are placed in the correct position and the Achilles tendon is stretched, called a tenotomy. Although it is also effective and improves the appearance of the child's foot, it is possible that over time the child will lose strength in the muscles of the legs and feet, which over time can cause pain and become stiff.

In addition, physical therapy for clubfoot can help by improving correct foot position and strengthening the child's leg and foot muscles.

Surgery for congenital clubfoot

In cases in which the Ponseti method is not effective, surgery may be indicated, which must be performed before the child is 1 year old. In this surgery, the feet are placed in the correct position and the Achilles tendon is stretched, called tenotomy.

Although it is also effective and improves the appearance of the child's foot, it is possible that over time the child will lose strength in the muscles of the legs and feet, which over time can cause pain and become stiff.

In this way, physical therapy for congenital clubfoot can help strengthen the leg muscles and help the child support the feet properly. Physical therapy treatment for congenital clubfoot includes manipulations, stretches, and bandages to help position the feet.

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