Nursing Care Plan - Clubfoot or Talipes Equinovarus

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Clubfoot or Talipes Equinovarus is a congenital anomaly in which the foot is plantar flexed at the ankle and subtalar joints, the hind foot is inverted, and the midfoot and forefoot are adducted and inverted. Contractures of the soft tissues maintain the malalignments. The exact cause of clubfoot is unknown, but genetic factors may include intrauterine infection, bone infection, vascular and nerve lesions have been suspected. Complications include “rocker bottom” deformity, disturbance in growth, and recurrent or residual deformity.

TREATMENT

All cases of clubfoot need treating - the earlier the better. Less severe and more flexible types are casted - the more severe and rigid types need surgery.

Casting
A series of plaster or fiberglass casts are applied to the foot and lower limb - these are replaced every few weeks, which each cast progressively moving the foot towards a more corrected position. The number of times the cast needs to be replaced will be determined by the severity of the clubfoot (but several months is not unusual). Most activities are not hampered by wearing a cast.
Surgery
If cast treatment fails or the clubfoot is rigid, surgery may be needed. This is not usually done until the child is between four and eight months of age.

There are a variety of surgical procedures which may be done in isolation or in combination:

• Soft tissue surgery that releases the tight tissues around the joints and results in lengthening of tendons so the foot can assume a more corrected position
• Bony procedures such as “breaking bone” and resetting the bone to correct deformities, or fusing joints together to stabilize joints to enable the bones to grow solidly together.
• Tendon transfers to move the tendons to a different position, so they can move the foot into a corrected position.

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