CONGENITAL DEFORMITIES
Pes clavus[claw foot
Definition
Is a deformity of the foot which has high area and is relatively stiff .
Cause
Risk factor
Heredity sensorimotor neuropathies or Charcot-Marie-Tooth syndrome.Spinal tumour or brain tumour, ,spinal tumour,spinal trauma,muscular dystrophy,cerebral palsy,polio,spinal nerve root injury.
This condition is caused by an imbalance between the agonist and antagonist muscles in the foot.
Pathophysiology
Ahigh arch with a medially angulated heel is called pes cavovarus. In cases where the primary deformity is excessive ankle and hindfoot dorsoflexion it is called calcaneovarus.
Medical management
Non surgical rehabilitation approaches include stretching,weak muscles and strengthening of tight and debridgement of plantar callosities, osseous mobilisation, message, chiroplastic manipulation of foot and ankle and strategies to improve balance.
Surgical management
Soft tissue procedures which are plantar fascia release, Achilles tendon lengthening ,tendon transfer. Osteotomy which are metatarsal,midfoot or calcaneal. Bone stabilising procedures which are triple arthrodesis.
Nursing management
The nurse should assess factors that worsen the pain such as position,swelling,pressure or infection or factors that make the pain less such as position,analgesics and dressings and provide care .Administer analgesics as per prescription.Encourage active range of movement exercises of joints that are not immobilised.
Teach the patient resistant exercises for unaffected extremities. The nurse must assess joints daily for contractures and muscles and monitor vitals signs .Nurse the patient in a cot bed to avoid falls.
Health education
The patient must adviced to not push objects and must elevate limb with the pillow to increase venous return and must observe for swelling ,pain and report.
Pes planus[flat foot]
Definition
When the entire sole of the foot is in contact or near contact with ground while standing.
Risk factors
Obesity, high blood pressure, diabetes, aging, rheumoid arthritis,
causes
Genetic factors as the flat feet can pass from parents to children in the genes.arthrits,muscular dystrophy
Assessment and common findings
Feet tired easily, painful or achy feet,back and leg pain ,foot movement such as standing on your toes,pain in the heel .
Pathophysiology
The medial longitudinal arch is made up of the calcaneous,navicular,talus,cuineiforms and first ,second and third metatarsal.The portion that is dysfunctional of the medial longitudinal may result in acquired pes planus.
Medical management
corticosteroids are used to reduce inflammation and the use of splints and casts to correct the foot.
Surgical management
The fusing of the foot or ankles together. Removing bones ,cutting the shape of the bone, cleaning the tendons's protective coverings, adding tendons in your foot to help balance the pull of the tendons and form arch. Grafting bone to the foot.
Nursing management
The patient is nursed in a comfortable position. Apply ice on the area to relieve pain. Monitor vital signs four houly and Administer the corticosteroids to relieve the inflammation. Restrict the patient to bed rest and .Observe for swelling, pain, bleeding and report abnormalities .The nurse must clean the cast area and observe after for colour. Elevate the leg to increase circulation to the limb.
Health education
The patient must be encouraged to apply ice on the foot and a void activities that put excessive stress on the foot like running and avoid soccer and hockey.