Congenital deformities of the foot
Gene varum
Definition
risk factors
It is the normal bowing of the legs in infants and going children. It resolves when the child is going to stand upright and start walking properly.
Rickets and arthritis is a risk factor for gene varum
Causes
Rickets ,bone tumour,fracture,paget's disease of the bone,brittle bone disease,vitamin D defiency ,tibia vera,arthritis,infection
Assessment and common findings
Bow legged while the child walking and standing .Long gap between two knees.Discomfort walking pattern it does not create any create any pain.
Pathophysiology
Gene varum is known as bowed legged.It is a deformity where there is lateral bowing of the legs at the knees.This is due to defective growth of the medial side of the epiphyseal plate.It is commonly seen unilateral and seen in conditions such as rickets, Paget's disease and severe degree of osteoarthritis of the knee. The degree of deformity is measured by distance between the medial femoral condyles when the patient is lying.
Medical management
Braces can be used to support the legs to walk.
Surgical Management
It is the surgical treatment to cut a part of excess bone below the skin in the leg for the correction of bow legged and avoid growing of excess bones and straighten the bone formation.
Nursing management
The patient must be nursed in a fowlers position and on bed rest. Encourage the child eat food with vitamin D. The children need to be encouraged to do exercises for the lower limb joints.The vital signs must be observed two hourly to detect any abnormalities.The site of the operation must be observed and monitored for bleeding. The dressings must be changed each day.Administer analgesics to relieve pain.
Health education
The guardian must be educated about eating food with vitamin d and to be exposed to sunlight to get vitamin D and to prevent rickets
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Gene valgum
Definition
Is a condition in which the knees knock each other when the legs are straightened.
Risk factors
Vitamin D defiency, calcium defiency, obese
causes
Injury to or infection in your knee or leg.Bone malformation from rickets, a disease caused by lack of vitamin D and calcium defiency. Other bone diseases and obesity
Assessment and common findings
Stiff joints, knee pain,walking with a limp and pain in the hips and ankles and lack of balance when standing.
Pathophysiology
In gene valgum the distal portion of the knee joint which bends s outwards and therefore the proximal portion seems to be bent in wards causing the knees to knocked together.
Medical management
Splints can be used to support the legs and bracing also correct the area.
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Surgical management
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Hemiepiphysiodesis or physeal tethering which are staples screws or plate of medial side.Which is done to a patient who is more than10 years old and the line drawn from center of femoral head to the center of the ankle falls in lateral quadrant of tibia plateau in patient less than 10 years of age ,it is used to avoid physeal injury place them extraperiosteally. Also used to avoid overcorrection follow patients often. The growth will begin within 24 months after removal of the tether.The distal femoral varus osteotomy it is used for insufficient remaining growth for hemiepiphysiodesis.
Nursing management
Nurse the patient in a comfortable position .Monitor the site for swelling, pain and bleeding from where the screws are at . Observe that the screws do not disloadge. Clean the screws using aseptic technique. Encourage the patient to move freely the legs but with care and do not push objects so that there is no unnecessary weight carried on the limb. Do vital signs observation four hourly. Administer analgesics relieve pain.
Health education
The nurse should advice the guardian to eat food with calcium and vitamin D and not move around pushing objects and must observe for pain, swelling, bleeding and report.
Talipes Equirovarus[club foot]
Definition
Is a birth defect where are or both feet are rotated in wards and downwards. The affected foot ,calf and leg may b
Assessment and common findings
Causes
Risk factors
Gender is a risk factor since it is more common in males than females. Genetics, family history , too little amniotic fluids during pregnancy.
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Itmay be linked to skeletal abnormalities such as spinalbifida cystica or a developmental dysplasia of the hip.It may because of a disruption in a neuromuscular pathway possibly in brain, spinal cord a nerve or muscle
The foot points downward and the toes may be worked inward. The foot appear to be sideways or sometimes even upside down.
The foot may be smaller than a normal foot by up to half - inch. The muscles that are calved on the affected area may not be fully developed. The foot may be limited to a range of motion.
Pathophysiology
There defective cartiliganious anlage of the tatus which causes further abnormal or arrested development. Distal limp amniotic banding happens. The amnion forms constructive bands around a limp in the uterus. Which results in cutting off the circulation to the limp. Which causes arrestment of the fetal development.
Medical management
Ponseti method can be used and it is where by the specialist manipulates the baby's foot with their hands. The doctor are trying to correct the bend in the foot. The plaster cast is applied from the toes to the thigh to hold the foot in the position. The plaster cast is changed each time the foot is corrected a little more. The process may be done for four to ten times using four to ten new casts.The patient needs to wear the special boots attached to a brace to hold the foot this will prevent relapse and will wear them for twenty three hours per day. then after they wear it at night until ages of four .The tapes and splints continue until the child is two years old.
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Surgical management
Surgery is used to adjust the tendons, ligaments and joints in the foot and ankle. Achilles tendon are released or the tendon is moved from the front of the ankle to the inside of the foot. The invasive surgery releases soft tissue structures in the foot..Then the surgeon then stabilises the foot using pins and a cast.
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Nursing management
The nurse must provide information about the nature and to alleviate anxiety. The nurse must ensure that the part to be put on is clean and dried. The neurovascular status of the part to be in cast must be assessed in relation to oedema and skin lesions and colour of the toes must assessed by the nurse. Ensure that padding the cast is applied to decrease friction. Position the patient and maintain the position. After 48 hours being applied observe for swelling, pain, cold sensation on the distal part to the cast. Observe for cyanosis of the toes and the fingers in the affected limp, pulse and the temperature of the distal part to cast.
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Health education
The patient must be advised not to try to move around and excessive use of the limb in the cast and not push objects I and not scratch to relieve itching and keep the plaster dry and elevate the limp to increase circulation to the limp.