Advanced Treatment of congenital deformed foot by mini external fixation
Treatment of congenital deformed foot is now possible by reliable & advanced technology of mini external fixation .
Deformed foot is known as clubfoot. This is a congenital defect that is present since birth. The incidence is quite high approximately 1-4 per thousand live births. It can be unilateral or bilateral (one or both feet affected).
A normal foot is made up of a number of small bones which together constitute various small joints. There joints make the foot supple. In club foot bones are normal in shape but altered in position so foot is not supple. If deformity persists the shape of bones also gets deformed & this adversely affects the prognosis. The pathology of club foot is not known. It may be hereditary. The worst part of this deformity is that it can recur even after treatment. The recurrence can be minimized by proper after care.
Treatment of club foot starts just after birth. For 6-7 days after birth skin of newborn is very soft so regular exercises are advised. After one-two week serial plaster casts by a new technique ponseti method are advised to achieve correction of deformity & after correction special type of shoes are advised.
If these measures are not taken seriously the deformity will persist. In that case surgery is the only answer for correction. Any negligence leads to rigid and inelastic foot. Because of the deformity, the child walks on side/ border of foot and hence skin of that side becomes thick and hard.
aim of treatment is to obtain a plantigrade, supple, cosmetically acceptable foot. A child born with clubfoot should be given proper attention right from the very beginning. After birth, first three weeks are very important and are called the Golden period because a hormone relaxin enters the child’s blood at the time of delivery, through the fetoplacental circulation. This makes foot supple & amenable to stretching. In initial 10-14 days usually it is not possible to apply plaster because skin of newborn is very soft & immature & thus unable to tolerate plaster. In this period it is advised that the mother should do manipulation of the deformed foot 4-5 times a day or after every feed, till skin is mature enough to accept the plaster.
Serial plaster cast method is thus started after 2-3 weeks of delivery. Six to eight number of plasters are applied for a duration of 2-3 weeks each. Usually after 6-8 plaster cats complete correction of deformity occurs, and then the child is made to wear day and night a special type of splint called the Denis Browne splint. This splint should be removed one two times in a day for 5 minutes each for doing manipulation. Later on when child reaches walking age, walking shoes are given while the child should wear Denis Browne spilt at night.
Sometimes even after 6-8 plaster casts, full correction is not achieved and then two surgical modalities are available for correcting the remaining components of deformity:-
Traditional Surgical soft tissue release procedure in which incision is given to expose the ligaments & tendons, which are then cut to achieve correction. Sometimes in older children (above 3 years) it may be required to cut the bone as well, to achieve correction.
An advanced and more reliable treatment is , external fixation system. This modality is useful for :-
Deformities which remain uncorrected after plaster of have recurred after achieving correction by plaster cast method (Relapsed cases).
Case which have been operated previously by traditional surgical procedures by there has been recurrence of deformity.
Case which have not taken any proper treatment (Neglected Cases).
Case which are resistance to other modalities of treatment (Plaster Cast method, traditional surgical procedure).
Nowadays this technique is very popular. The principle is that when a stretching force is given to a soft tissue it results in regeneration of tissue (Histogenesis). Not only does the contracted soft tissue regenerates but the muscles, nerves and bones also grow simultaneously. In this modality of treatment, nerves and bones also grow simultaneously. In this modality of treatment, wires are placed in the bone, and by increasing the distance between these wires with help of distraction, gradual stretching of soft tissue is obtained. This process is called Distraction. The resultant foot is thus more supple and there is achievement of gain in foot length, as compared to the foot treated by surgical release operation. For this semi invasive surgery, hospital stay is only for one or two days. Parents are explained about the way of rotating the knob of the distracter so that they can do this at home later. After one and a half to two months the fixator is removed and one to two walking plasters are given followed by walking shoes.
The main advantage of this new technique is that the chances of recurrence of deformity are minimal. Any age between one to ten years is suitable for this modality of treatment. In older children upto 15-18 years, correction can be achieved by a combined procedure which includes external fixator and the traditional surgical operation.
This mini external fixater technique is not only good for the foot by can also take care of finger & wrist fractures, which may be of simple type or associated with a wound. Even thresher injury cases with chopped fingers can be treated well by this mini external fixator technique.