#Talipes Equinovarus

[ankleandfootcentersofamerica]

Comprehensive Club Foot Care | Nurturing Healthy Steps

Discover comprehensive care for Club Foot at Ankle & Foot Centers. From Club Foot treatment to advanced surgery, our specialized approach, led by experienced practitioners, ensures healthy steps and a brighter future for you or your child. Embrace effective solutions and renewed mobility.

[meeshuggeneh]

“Maternal impression” or “maternal imagination” is the belief, common across many cultures from antiquity to the advent of genetic science, that the things a mother sees or feels during her pregnancy can literally imprint themselves on the fetus. If, during pregnancy, the mother saw, dreamt of, or touched a particular animal or grotesque image, she could generate a “deformed”* child. A cleft lip, historically called a harelip, was said to be the result of a mother seeing a hare or rabbit during pregnancy. By this same principle, a pregnant person who sees (and is frightened by) a harelipped person runs the risk of her baby being afflicted with the same birth “defect.”* And so on and so forth.

The most famous example of this theory in action is the widespread belief that Joseph Merrick, called the “Elephant Man” because his skin was described as thick and discolored like that of a pachyderm, was born this way as a result of his mother being frightened by a carnival elephant while she was pregnant with him.

According to psychiatrist Ian Stevenson, “Some physicians of the 18th and 19th centuries who…believe[d] in maternal impressions supposed that small nervous connections would be found between the uterus and the placenta and that these could somehow convey a mother's mental impression to her fetus.” By this same reasoning, some believed that it was not only visual stimuli which could affect the growing fetus, but the mother’s mental and/or emotional state could also be passed on to the child. A grieving mother would give birth to a melancholic child, for instance.

Whether by design or by accident, this theory held mothers accountable for congenital medical conditions over which they had no control. The theory of maternal impression is bound up in the same magical thinking that has historically linked the most visible birth “defects”* to occult forces. As medical historian Andrew Mangham notes, “they [birth defects] had a long experience of being converted into ‘portents signifying divine wrath and catastrophe.’”

Here are some other superstitions based on the doctrine of maternal impression: 

A mother who craved strawberries throughout her pregnancy might give birth to a child with a birthmark. Hemangiomas, one of the most common types of vascular birthmark, are commonly called “strawberry marks.”

A mother who saw or touched a speckled or spotted animal would give birth to a child with freckles.

A mother who experienced some kind of shock while pregnant, and touched her own face in an emotional response, would have a baby with a birthmark in the same spot.

Aztecs believed a lunar eclipse was the result of a bite being taken out of the moon. This idea translated into the Mexican superstition that if a pregnant woman viewed an eclipse, a bite would be taken out of her unborn child's face.

If an expectant mother tripped over a gravestone and twisted her ankle, her child would be born with a clubfoot (congenital talipes equinovarus).

A mother who sees a frog or toad will give birth to a child with webbed fingers or toes (syndactyly).

In some cultures, anomalous births were treated as miraculous and/or as omens, indicating the future lying in store for the child’s family or nation. ln my next post, I will discuss some of these superstitions.

*The commonly-used terminology of anomalous births is used here for the sake of clarity, but contained in quotation marks because it pisses me off. “Defect,” “deformity,” “malformation,” etc. are all deeply troubling ways to describe a person’s inborn bodily state.

Sources: Armstrong, Elizabeth Mitchell. “Making Sense of Advice About Drinking During Pregnancy: Does Evidence Even Matter?.” The Journal of perinatal education vol. 26,2 (2017): 65-69. doi:10.1891/1058-1243.26.2.65

Mangham, Andrew. We Are All Monsters: How Deviant Organisms Came to Define Us. MIT Press, 2023. Print.

Stevenson, Ian. “A New Look at Maternal Impressions: An Analysis of 50 Published Cases and Reports of Two Recent Examples.” Journal of Scientific Exploration, 1992.

[kidsorthopedic]

Congenital Clubfoot: Symptoms And Causes

Clubfoot is one of the most common birth defects of the foot. Out of one thousand new-born babies, one to two have this deformity. This deformity affects a new-born’s muscles, tendons, and blood vessels. It is caused when the tissues that connect the muscles to the bone are not the usual size. In congenital clubfoot, one or both feet are rotated downward and inward. It is also known as congenital talipes equinovarus in medical terms, and the child born with this deformity can’t place their foot flat on the ground for walking. Clubfoot is not painful, but if this congenital disease is not treated on time, the foot will remain deformed forever. Mostly, clubfoot can be treated without surgery, but in severe cases, follow-up surgery is required later on.

 Types of Clubfoot

Clubfoot can be divided into two major categories non-isolated clubfoot and Isolated (idiopathic) clubfoot. Isolated clubfoot is a common musculoskeletal birth defect. It generally occurs without any other medical problems. On the other hand, non-isolated clubfoot happens along with other serious medical problems, including arthrogryposis and spina bifida. Arthrogryposis is a joint problem, and spina bifida is a neural tube disorder. If anyone in your family has clubfoot, your baby will be at higher risk of congenital clubfoot. Also, boys are at a greater risk of developing clubfoot than girls. Babies also have a higher chance of developing clubfoot if they have another birth defect known as spina bifida. Women who had oligohydramnios during pregnancy are also at a higher risk of having a clubfoot baby.

 Symptoms of Congenital Clubfoot

If your new-born baby has clubfoot, their foot will be twisted inward and downward. The affected foot or leg will also be slightly shorter. In some cases, the foot is so severely turned that it seems as if it is upside down. Clubfoot is a serious health concern that will not improve on its own without any treatment. A baby with untreated clubfoot will use the outer edge of their foot to walk, leading to painful calluses. But with proper treatment, clubfoot can be treated, and your baby can lead a normal life.

 How can clubfoot affect your baby

Clubfoot will not affect your baby until your child starts to walk. Untreated club food can limit your baby’s daily activities. They might have difficulty walking, standing, and wearing their shoes. A child with clubfoot may walk on the top and side of their feet. Clubfoot can also lead to calluses which is a thick layer of skin that usually develops on the foot’s sole. It can also lead to arthritis, a disease that causes stiffness and painful inflammation of the joints.

 Causes of clubfoot

The definite cause of clubfoot has still not been identified by the researchers. But according to a popular theory, clubfoot is caused due to environmental and genetic factors. Families with a history of clubfeet are at higher risk of this disease. If a pregnant woman has one child with clubfoot, their chance of having a second child with this deformity is 1 in 35. In some cases, clubfoot is also linked to spina bifida, a congenital deformity that mostly occurs when the spinal cord and spine have not formed properly. Sometimes it can be linked to a developmental dysplasia of the hip or a developmental hip condition called hip dysplasia. If one of the parents has clubfoot, there is a 1 in 30 chance that your baby will have it. In 20016, research was conducted in which it was shown for the first time that a gene variation that processes folate in the body might be the cause of clubfoot.

[mobility-hdprosthetic-2024]

The Dennis Browne Splint is an orthopedic appliance most commonly used for the treatment of congenital talipes equinovarus, also known as clubfoot, in infants and toddlers. Two shoes are attached by a bar to sustain proper, plantar-derotation positioning of the feet. The Dennis Browne Splint maintains this positioning to gradually correct foot deformities and help avoid recurrence should they have been initially corrected with casting or surgery.

It is usually applied following a Ponseti method of serial casting as a retention device for long-term management to maintain the proper alignment of the feet. The splint is used full-time in early infancy and less often as the child grows. It is designed to allow movement but to keep the feet in the correct alignment necessary to correct the abnormality. It is a non-surgical effective way of managing clubfoot and has been followed in most of the instances with total success by being strictly followed according to prescribed protocols.

[drforambhuta]

Common Pediatric Orthopedic Conditions:

1. Developmental Hip Dysplasia (DDH): DDH involves hip joint abnormalities, requiring early screening and treatment like braces or surgery for severe cases, particularly common in females and breech-positioned infants.

2. Clubfoot (Congenital Talipes Equinovarus): This condition, affecting 1 in 1000 births, demands personalized treatment plans, ranging from casting to corrective surgeries, to address inwardly twisted feet and tight Achilles tendons.

3. Scoliosis: Vigilant monitoring and intervention, including bracing or surgery for moderate to severe cases, are essential to manage lateral spine curvature during adolescence and mitigate associated symptoms.

4. Osgood-Schlatter Disease: Characterized by knee pain in active adolescents, this condition necessitates conservative measures like rest and physical therapy to alleviate symptoms and prevent recurrence.

5. Pediatric Fractures: Children's fractures require appropriate immobilization and follow-up care to ensure optimal healing and minimize long-term complications, with surgery reserved for complex cases.

6. Neuromuscular Conditions: Disorders like cerebral palsy and muscular dystrophy require multidisciplinary management to address musculoskeletal abnormalities and optimize mobility through tailored interventions.

7. Limb Length Discrepancy (LLD): LLD may be managed conservatively with orthotic devices for mild cases or surgical procedures for significant discrepancies to achieve functional harmony.

8. Pediatric Sports Injuries: Prevention strategies and prompt management of sports-related injuries are crucial for minimizing downtime and preventing long-term complications in children and adolescents.

9. Genetic Disorders: Conditions like Marfan syndrome and osteogenesis imperfecta require a multidisciplinary approach to address musculoskeletal manifestations and associated complications through various treatment modalities.

Orthopedic conditions can be detected and treated early-on in children by opting for a regular full body health checkup for children at a good hospital.

[goldmedalphysiotherapy]

Treating Various Conditions at Gold Medal Physiotherapy

Discover effective treatments for dyspnea, congenital talipes equinovarus (CTEV), and myasthenia gravis at Gold Medal Physiotherapy. From addressing the causes to managing symptoms, our team of experienced physiotherapists offers personalized care to improve your quality of life. Whether you're seeking relief from breathing difficulties, managing CTEV in yourself or your child, or navigating the challenges of myasthenia gravis, we're here to help you regain strength, mobility, and overall well-being. #Physiotherapy #DyspneaTreatment #CTEV #MyastheniaGravis #TreatmentOptions #Healthcare

[dkpsphysiocare]

WHAT WE TREAT

We offer treatments across neuro /ortho / pediatrics /sports related issues using approved procedures in Physiotherapy, Chiropractor, Dry Needling, Kinesiology etc.

CONDITIONS

Varicose Veins

Popliteal (Baker's) Cyst

Posterior Cruciate Ligament(PCL) Injury

Lateral Collateral Ligament(LCL) Injury

Medial Collateral Ligament (MCL) Injury

Patella Dislocation

Patellar Fracture

Meralgia Paresthetica

Hip Osteoarthritis

Hip Impingement

Hip Labral Tear

TROCHANTERIC BURSITIS

Hip Fracture

Radial Tunnel Syndrome

Biceps Tendonitis

Cubital Tunnel Syndrome

De Quervain's tenosynovitis

Burns

Ganglion Cyst

Boutonniere Deformity

Mallet Finger

Hand Fractures

Wrist Fracture

Forearm Fractures

Elbow Fractures

Shoulder and Arm Fractures

Shoulder Dislocation

TORTICOLLIS

Down Syndrome

Spina Bifida

SPRENGEL'S SHOULDER

ERB’S PALSY

MENISCAL INJURY

Total Hip Replacement (THR)

Total Knee Replacement(TKR)

Fibromyalgia Syndrome

Hamstring Strain

Clubfoot or Congenital Talipes Equinovarus or CTEV

Stroke or Cerebrovascular accident (CVA)

Temporomandibular Joint (TMJ)

Asthma

Distal Muscular Dystrophy

Degenerative Disc Disease

Diabetic Neuropathy

Herniated Disk or Slipped Disc

Myasthenia Gravis (MG)

Tendinitis

Piriformis syndrome

Tailbone Pain/Coccydynia

Rheumatoid Arthritis

Spinal Stenosis

Concussion

Plantar Fasciitis

Dementia

Bell's Palsy or Facial Palsy

Scoliosis

Rotator Cuff Injury

Whiplash

Osteoporosis

Cervical Myelopathy

Osteoarthritis

Baastrup syndrome

Tennis Elbow

Parkinson's Disease

Sciatica

Cerebral Palsy

Ankle sprain

Anterior Cruciate Ligament Tear

Knee Bursitis

Chondromalacia Patella

Arthritis

Carpal Tunnel Syndrome (CTS)

Achilles Tendon Rupture

Vertigo

Frozen Shoulder

Cervical Spondylosis

Lumbar Spondylosis

SYMPTOMS

Muscle Spasm

Tremors

Joint Cracking

Foot Pain

SPRAINS AND STRAINS

Shortness of Breath

Headache

Numbness and Tingling

Inflammation

Loss of Balance

Muscle Stiffness

Shoulder Pain

Joint Pain

Neck Pain

Back Pain

Knee pain

OUR OFFERINGS

At drsinghphysiocare (DKPS) we use physio care approach providing a combination of therapies for comprehensive healing.appoved modalities are used only

[gsuniversityofficial]

Orthopaedic Patient Review - Diagnosis - Congenital Talipes Equinovarus (CTEV) | Treatment Done by Dr. Priti Ranjan Sinha (Orthopaedic Surgeon)

GS Superspeciality Hospital, Hapur, Delhi Ncr

Book an Appointment Now:

Contact Us: +91-7055514537

For online Appointment Visit: https://gshospitals.in/appointment.php

Address: NH-9, Near Railway Station Pilkhuwa, Hapur (U.P.)

Our College Website: https://gsmedicalcollege.in

[dailyrandomwriter]

Day 329

So I’m getting new shoes!

Yay!

And instead of black they will be brown, because I already have black shoes and I want cute brown booties and pretend I’m a cottage lady.

But let me tell you, I was reminded a few weeks ago why I procrastinated on getting new shoes. Every other person who says shoe shopping is a nightmare talks about how it’s hard to find a shoe that fits them, that looks good and fits them, that doesn’t cost an arm and a leg.

For me with my AFO wearing foot that is on a leg that is shorter than the other, it is convincing the insurance company that yes, I need these shoes, I cannot modify off the shelf shoes, please let me have these shoes it has been five fucking years and the soles on the current ones need to be replaced.

I did my due diligence, I got a prescription from the doctor (aka letter of support), got the invoice from the shoe people that indicated that this was for medical use. It was declined the first time, because someone only read the ‘talipes’ portion of the diagnosis and wrote back that it was a foot structure and not a diagnosis. Instead of reading ‘talipes equinovarus’ which is a very fancy way of saying I have clubfoot.

The ironic part of this story is that the day I got declined for the shoes by the insurance company was the same day they approved to pay for my portion of the new ankle foot orthotic (AFO) I had also had to replace. Which is, by the way, considered a medical device according to the government and I had the paperwork to prove it which I had sent to the insurance, which was why the AFO was approved.

And that doesn’t even cover the fact they wanted to know what lab or shop was making my shoes and what their contacts were; how did they mold my feet, and what did they see while doing the molding that would support the need for specialized shoes. The poor doctor and the poor admin people at this place had to redo all the paperwork.

To say I may have passive aggressively written my own letter pointing out that ‘tailpes equinovarus’ is the medical term for clubfoot, and then added the AFO paperwork, pointing out that they had approved of that AFO, is maybe a bit of an understatement. 

In good news, they approved the shoes. I'm getting new shoes.

[mdorthopadics]

Clubfoot Treatment for Babies usually involve a combination of stretching and bracing, as well as surgery if needed. The goal of treatment is to ensure the feet are properly positioned, so that your child can walk normally and without pain. Treatment should be started in the first week or two of life in order to take advantage of the favorable elasticity of the tissues forming the ligaments, joint capsules and tendons. With our treatment these structures are stretched with weekly, gentle manipulations. The first step in treating clubfoot is to identify the severity of the condition and decide which steps are necessary. Mild clubfoot cases can often be treated without surgery, while more severe cases may require surgery.

Clubfoot is a birth defect where a baby’s foot appears twisted and turned inward. It’s also known as talipes equinovarus. Although it can sometimes be present in both feet, clubfoot usually affects just one. Fortunately, clubfoot is treatable and doesn’t usually cause any long-term problems or disability. The most common treatment for clubfoot is the Ponseti Method. This method involves a series of manipulations and casts that gradually move the foot into the correct position. It’s usually started within the first few weeks of a baby’s life and usually takes four to eight weeks to complete.

[ankleandfootcentersofamerica]

What Is Club Foot (Talipes Equinovarus)?

Club foot, otherwise known as talipes equinovarus, is a congenital deformity of the foot that causes it to turn inward and downward. This condition can affect one or both feet, resulting in clubbed feet, in which the heel of the foot faces inward and the toes point outward.

[bronva]

Mum launches support platform for brides after battling trauma planning her own wedding

Mum launches support platform for brides after battling trauma planning her own wedding

Amy wants to help other brides (Picture: PA Real Life) A mum-of-two has launched a support platform to help stressed out brides after battling trauma while planning her own nuptials. After getting engaged, Amy Patterson, 24, from Manchester, became overwhelmed when her son Charlie, now 15 months, was diagnosed with talipes equinovarus, also referred to as club foot.  He went onto become severely…

[cannondisabledcharacters]

Questions:

Maybe a new poll about how many posts a day is needed again?

Have you learned about new disabilities through suggestions on this blog? If so, which ones?

Disabilities you wish had better representation?

Countries you wish to see more characters from?

Do you think people would like to have a discord related to the topics of this blog?

You found Watermelon through this blog, have you found more stories you've gotten really fond of through requests?

Do you wish there were more toys here?

Disabilities you're surprised has representation?

Non-human creature you've been surprised to see here?

Series you can't ban because it technically doesn't break any of the rules, but wish nobody would request characters from?

Series you wish wasn't on the ban list?

Series you are considering putting on the ban list for some the content/history behind it, but not sure if it's a good idea?

Story you don't like but has some neat representation even if the story wasn't very good?

Character you've had to refuse many times? Someone like Kylo Ren for example, comitter of patricide yet his fans feel sorry for him because he "saw his dad die"?

Decade/era you want to see more characters from?

Series/game you wish to get into but can't because lack of translation/release where you live?

Childhood favorites?

Character you wish to change your avatar to next year?

Most absurd phobia? (Those with them have no need to be ashamed though)

Cutest/coolest characters?

Hopefully it came through..!

Maybe a new poll about how many posts a day is needed again? I'm keep it 4 a day, it's already hard enough to keep up with

Have you learned about new disabilities through suggestions on this blog? If so, which ones? Answered this question already today, I'm just gonna repost the answer. "Yes too many to count. Lots of times I look for disorders medical name so I can be as accurate as possible and avoid offensive language. Some examples: Constant chronic runny nose = Chronic Rhinorrhea, “Club foot” = Talipes Equinovarus, “Hunch Back” = Kyphosis"

Disabilities you wish had better representation? Personality disorders

Countries you wish to see more characters from? Countries from Africa! I believe I have the least amount representation from Africa, especially southern half of Africa.

Do you think people would like to have a discord related to the topics of this blog? I would rather not be involved in any discords. Discords while nice to have people to talk to, is very difficult to moderate. I don't have the energy to regulate one.

You found Watermelon through this blog, have you found more stories you've gotten really fond of through requests? Yes! I've been really jamming with Indentity V and Cookie Run rn

Do you wish there were more toys here? I wish there were more toys in general that had different body types and disability representation

Disabilities you're surprised has representation? Not really, I'm more suprised when I find good representation because lots of media is super ableist

Non-human creature you've been surprised to see here? Not really, I'm just happy there is diversity. I personally relate to a lot of non-human characters

Series you can't ban because it technically doesn't break any of the rules, but wish nobody would request characters from? YES, but I don't wanna have discourse on my blog about it. I will say some series are banned because they trigger me, not every series banned is bad.

Series you are considering putting on the ban list for some the content/history behind it, but not sure if it's a good idea? Yes, similar answer to the question above.

Story you don't like but has some neat representation even if the story wasn't very good? I guess? Imma be real I havn't explored most series on this blog past checking they don't voilate rules or reviewing the character.

Character you've had to refuse many times? Every time I open the box I get a request for Anakin Skywalker, y'all he literally kills children and is part of many genocides. Please don't request him

Someone like Kylo Ren for example, comitter of patricide yet his fans feel sorry for him because he "saw his dad die"? Keep me out of the Stars Wars discourse

Decade/era you want to see more characters from? Current time, I wanna see the world's representation of disability get better in my life time.

Series/game you wish to get into but can't because lack of translation/release where you live? There are literally too many to count, I love media from around the world

Childhood favorites? Uh, I really liked Warriors as a kid. In my younger years (and now) I loved Full Metal Alchemist and Fire Emblem

Character you wish to change your avatar to next year? Yeah not sure who yet

Most absurd phobia? (Those with them have no need to be ashamed though)? Please don't call a phobia absurd. Here something folks, I have a phobia of metal measuring tapes. This is not a joke. There is no name for it, but every time hear them move my heart beat raises. I can only touch them with thick gloves and hate being around them. They make me feel unsafe, even if I just see a picture of one. I have been made fun both by peers and coworkers. My phobia comes from trauma, I shouldn't have to go in detail to be respected. Because of the job I have to be around them sometimes. I dread telling someone I don't like using them. I literally had a coworker walk up to me and shake one in my face. Please respect peoples phobias and triggers.

Cutest/coolest characters? I like monster girls

[kidsorthopedic]

Orthopedic Screening of Newborns: A Comprehensive Overview

Orthopedic screening of newborns is a crucial aspect of neonatal care, aiming to detect musculoskeletal abnormalities early on. Identifying conditions at birth allows for timely intervention, which can prevent long-term disabilities and enhance the quality of life. This comprehensive article delves into the significance, methods, common conditions detected, and the implications of orthopedic screening in newborns.

Introduction

The birth of a child is a momentous event, accompanied by a myriad of emotions and responsibilities. Among the numerous checks and screenings a newborn undergoes, orthopedic screening stands out as an essential process. The primary objective is to identify congenital musculoskeletal anomalies that, if left untreated, can lead to significant morbidity. Early detection facilitates appropriate treatment, ensuring the child’s optimal development and functioning.

Importance of Orthopedic Screening in Newborns

Orthopedic screening in newborns is pivotal for several reasons:

Early Detection of Congenital Anomalies: Early identification of conditions such as developmental dysplasia of the hip (DDH), congenital talipes equinovarus (clubfoot), and limb abnormalities allows for prompt treatment, often leading to better outcomes.

Prevention of Long-term Disabilities: Untreated musculoskeletal conditions can result in long-term disabilities, affecting a child’s mobility and overall quality of life. Early intervention can prevent or minimize these consequences.

Reduction of Healthcare Costs: Early diagnosis and treatment can reduce the long-term healthcare costs associated with managing chronic disabilities and complications arising from untreated conditions.

Parental Reassurance: Early screening and intervention can alleviate parental anxiety by providing clear diagnoses and treatment plans.

Common Orthopedic Conditions in Newborns

Several orthopedic conditions can be detected during neonatal screening. The most common include:

1. Developmental Dysplasia of the Hip (DDH)

Definition: DDH encompasses a spectrum of hip joint abnormalities where the femoral head is not properly seated in the acetabulum. It ranges from a loose hip joint to a completely dislocated hip.

Risk Factors: Family history, breech presentation, firstborn status, and being female are significant risk factors.

Screening Methods: The Barlow and Ortolani maneuvers are commonly used. These involve manipulating the hip to detect instability or dislocation. Ultrasound is used for confirmation and further evaluation.

Treatment: Early treatment includes Pavlik harness application, which maintains the hip in an optimal position for growth. Severe cases may require surgical intervention.

2. Congenital Talipes Equinovarus (Clubfoot)

Definition: Clubfoot is a deformity characterized by the foot being twisted inward and downward. It can be idiopathic or associated with neuromuscular disorders.

Screening Methods: Physical examination is usually sufficient for diagnosis. The foot’s position, rigidity, and appearance are assessed.

Treatment: The Ponseti method, involving gentle manipulation and casting, is the gold standard. Surgery is reserved for resistant cases.

3. Limb Abnormalities

Definition: These include conditions like polydactyly (extra fingers or toes), syndactyly (fused fingers or toes), and limb length discrepancies.

Screening Methods: Visual inspection and physical examination are the primary methods. Further imaging may be required for detailed assessment.

Treatment: Treatment varies based on the condition and severity. Surgical correction is often required for functional and cosmetic reasons.

4. Metatarsus Adductus

Definition: This condition involves the inward deviation of the forefoot. It is usually flexible and can be corrected with gentle manipulation.

Screening Methods: Physical examination reveals the inward deviation and flexibility of the foot.

Treatment: Most cases resolve spontaneously. Severe or persistent cases may require casting or surgery.

5. Torticollis

Definition: Torticollis is the shortening of the sternocleidomastoid muscle, causing the head to tilt to one side.

Screening Methods: Physical examination reveals limited range of motion and head tilt.

Treatment: Physical therapy and stretching exercises are the primary treatments. Severe cases may require surgical intervention.

Methods of Orthopedic Screening

Orthopedic screening in newborns involves a combination of physical examinations and, when necessary, imaging techniques. Here are the key methods used:

Physical Examination

General Inspection: The clinician observes the baby’s overall posture, limb symmetry, and any visible deformities.

Range of Motion Testing: Passive and active range of motion tests help identify joint limitations or abnormalities.

Specific Maneuvers: Techniques like the Barlow and Ortolani tests for DDH or manipulation tests for clubfoot are essential components of the physical exam.

Imaging Techniques

Ultrasound: Widely used for diagnosing DDH in infants, ultrasound provides detailed images of the hip joint without radiation exposure.

X-rays: Used less frequently in newborns due to radiation exposure, X-rays are reserved for specific conditions or older infants.

MRI and CT Scans: These are rarely used in the neonatal period but may be indicated for complex cases requiring detailed anatomical information.

Timing and Frequency of Screening

Orthopedic screening typically occurs at several key points:

At Birth: The initial examination identifies obvious abnormalities and high-risk conditions.

During Routine Check-ups: Follow-up screenings during well-baby visits help monitor development and detect conditions that may not be apparent at birth.

When Risk Factors are Present: Infants with known risk factors (e.g., breech presentation, family history) may require more frequent and focused screening.

Challenges in Orthopedic Screening

Despite its importance, orthopedic screening in newborns faces several challenges:

Variability in Screening Practices: There is no universal protocol for screening, leading to variability in practices and potentially missed diagnoses.

Skill and Experience of Clinicians: Accurate screening depends on the clinician’s skill and experience. Inexperienced practitioners may miss subtle signs.

Limited Resources: In resource-limited settings, access to advanced imaging and specialized care can be a significant barrier.

Advances and Innovations in Orthopedic Screening

Recent advances and innovations are enhancing the effectiveness of orthopedic screening in newborns:

Genetic Screening and Biomarkers

Research into genetic screening and biomarkers holds promise for identifying infants at risk for orthopedic conditions even before symptoms appear.

Artificial Intelligence (AI) and Machine Learning

AI and machine learning algorithms are being developed to assist in interpreting imaging studies, improving diagnostic accuracy and consistency.

Portable Ultrasound Devices

The advent of portable ultrasound devices allows for point-of-care screening, making it more accessible in remote or resource-limited areas.

Telemedicine

Telemedicine facilitates remote consultations and second opinions, ensuring that infants in underserved areas receive timely and accurate diagnoses.

The Role of Parents and Caregivers

Parents and caregivers play a crucial role in the early detection and management of orthopedic conditions. Educating them about the signs and symptoms to watch for, the importance of follow-up visits, and adherence to treatment plans is vital.

Signs and Symptoms to Watch For

Parents should be aware of signs such as:

Asymmetry in limb length or appearance.

Limited movement or stiffness in limbs or joints.

Persistent abnormal postures or deformities.

Importance of Follow-up Visits

Regular follow-up visits are essential for monitoring progress and adjusting treatment plans as needed. Parents should understand the significance of these appointments.

Adherence to Treatment Plans

Treatment for orthopedic conditions often involves prolonged and consistent interventions. Ensuring that parents adhere to the prescribed treatment plans, including the use of braces, casts, or physical therapy, is critical for successful outcomes.

Case Studies

Case Study 1: Developmental Dysplasia of the Hip (DDH)

Background: Baby A, a female infant, was born breech and had a family history of DDH. During the initial screening, the Barlow and Ortolani tests indicated hip instability.

Intervention: An ultrasound confirmed the diagnosis of DDH. Baby A was fitted with a Pavlik harness at two weeks of age.

Outcome: Regular follow-up visits and adjustments to the harness led to complete resolution of the hip instability by six months of age. Early detection and intervention prevented the need for surgical treatment.

Case Study 2: Congenital Talipes Equinovarus (Clubfoot)

Background: Baby B was diagnosed with bilateral clubfoot at birth. The feet were rigidly turned inward and downward.

Intervention: The Ponseti method was initiated at one week of age, involving weekly casting and manipulation.

Outcome: By three months, the feet were corrected to a normal position. Continued use of braces at night maintained the correction, preventing recurrence.

Future Directions in Orthopedic Screening

The future of orthopedic screening in newborns is promising, with ongoing research and technological advancements paving the way for more effective and accessible screening methods.

Integration of Genetic Research

Advances in genetic research may lead to the identification of specific genetic markers associated with orthopedic conditions, allowing for early risk assessment and targeted interventions.

Development of Advanced Imaging Techniques

Continued development of imaging techniques, including 3D ultrasound and advanced MRI protocols, will improve diagnostic accuracy and provide detailed anatomical information.

Expansion of Telehealth Services

Telehealth services will expand access to specialized orthopedic care, particularly in underserved areas. Virtual consultations and remote monitoring can ensure timely and effective management of identified conditions.

Training and Education

Enhanced training and education programs for healthcare providers will improve the accuracy and consistency of orthopedic screening. Simulation-based training and continuing education opportunities can keep practitioners up-to-date with the latest techniques and guidelines.

Conclusion

Orthopedic screening of newborns is a vital component of neonatal care, aimed at identifying and managing musculoskeletal conditions early on. Through a combination of physical examinations and imaging techniques, healthcare providers can detect conditions such as DDH, clubfoot, and limb abnormalities, facilitating timely and effective interventions.

[mobility-hdprosthetic-2024]

Understanding the Dennis Browne Splint: A Guide for Parents and Caregivers

Understanding the Dennis Browne Splint: A Guide for Parents and Caregivers

It is one of the orthotics appliances most used in pediatrics. The Dennis Browne splint has been very prized in the treatment of congenital talipes equinovarus, commonly referred to as clubfoot. A child's foot may enter the uterus and be born curled down inward. A child having such a foot condition needs to be constantly adjusted by this appliance after receiving such corrective treatment as surgery or the Ponseti method. Here is an extensive illustration of the Dennis Browne Splint, including the parts, what it does, and how it should be used:

Main Components

Bar: This is the central body of the splint. It is typically made of metal or rigid plastic and can be positioned between the shoes to prevent further movement. It can be extended up to the size and requirement of the child.

Feet: Shoes are secured onto the bar, and this immobilizes the child's feet in the corrected position. Shoes can, in fact, be designed with a 70-degree outward rotation to maintain the optimal foot alignment. Velcro straps or fasteners can then be added to lock the child's feet in place within the shoes.

Adjustability: The splint is highly adjustable both in the length of the bar and foot positioning for the child's growth and progressive treatment.

Main Purpose

The Dennis Browne Splint is applied after correction to achieve:

Maintenance of Position: After the process of serial casting or surgery, the feet are held externally rotated by means of the splint so that they do not revert to the clubfoot deformity.

Prevention of Recurrence: Clubfoot tends to recur a high percentage of cases, especially in the early developmental stages. A splint will keep the deformity minimized with proper foot positioning at all times.

Aid Early Mobilization: While the splint restricts a few movements to preserve the proper positions of the feet, it allows for partial mobilization, such as crawling or kicking, without disrupting the correction.

Treatment Schedule

The Dennis Browne Splint is usually used in the following stages:

Full-Time Wear: The infant is required to wear the splint 23 hours per day for the first 2-3 months after the correction. This step is necessary because, at the beginning, the soft tissues of the feet need to adapt to the new position of the corrected feet.

Gradual Weaning: During this time, the child grows and the recurrence is decreased gradually reducing the wearing time. However, after discontinuing full-time wearing, children may wear a splint only when they sleep and at night; generally, wearing time continues to continue until children become 4-5 years of age.

Monitoring and Adjustments: The child must regularly visit a healthcare provider to follow up on how the child is progressing, thus being able to readjust the splint and ensure proper alignment as the child grows.

Benefits

Non-invasive Technique: The main part of non-surgical treatment is a Dennis Browne Splint, especially its use following Ponseti casting. It provides a less invasive alternative compared to surgery.

Effective Long-Term Correction: There is a lesser chance of recurrence with the use of the splint as prescribed; they enable children to grow into normal foot function.

Cost-Effective: The use of the splint offers an affordable long-term solution to the management of clubfoot; it also reduces more extensive surgeries that could have been required in correcting clubfoot.

Challenges and Considerations

Compliance: One of the biggest challenges with the Dennis Browne Splint is ensuring consistent use. Parents must be diligent in adhering to the wearing schedule, as non-compliance can lead to a relapse of the condition.

Initial Discomfort: Some children may experience discomfort, especially during the initial stages of wear, as the feet are held in a specific position. However, this discomfort usually lessens as the child adjusts to the splint.

The Dennis Browne Splint is an agent that is standard in the treatment of clubfoot: this affords an excellent, reliable, nonoperative way by which the foot can remain aligned and not as likely to recur. Strict patient compliance to the wearing schedule, coupled with close follow-up by health professionals, are the most important requirements for satisfactory results using the device.

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Iris Publishers- Finding an Association Between Congenital Talipes Equinovarus (CTEV) and Developmental Dysplasia of Hip (DDH): Role of Early Ultrasonography

Abstract

Introduction: Congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip (DDH) are common congenital anomalies. An association between these two conditions has been proposed, but no consensus has been reached. Purpose: The purpose of this study was to determine the incidence of sonographic hip dysplasia in infants with idiopathic clubfoot.

Methods: All neonates with a confirmed diagnosis of CTEV who were referred to our paediatric orthopaedic service for two years were clinically examined and screened with ultrasound for DDH using the Graf method.

Result: A total of 50 babies with CTEV were identified, 47 patients had physiologic hip dysplasia and 3 were found to have dislocated hips. The incidence of DDH in babies with CTEV was found to be higher than the normal population in our region.

Conclusion: Our study indicates higher risk for DDH in presence of CTEV and CTEV patients should be considered particularly for selective hip screening in our population.

Abbreviations: Developmental dysplasia of the hip; Congenital talipes equinovarus; Clubfoot; CTEV; DDH

Introduction

Clubfoot or congenital talipes equinovarus (CTEV) and developmental dysplasia of hip (DDH) are conditions commonly encountered by orthopedic surgeons in their clinical settings. Both the conditions have unknown etiology. Genetic and environmental etiologies have been suggested for both, but with different pathways. Diagnosis of CTEV is simple and evident with clinical examination. DDH, on the other hand requires high clinical expertise for diagnosis and even the negative clinical signs do not rule out the condition completely. Ultrasound is recognized method to detect hip dysplasia. Routine clinical screening tests are sometimes conducted in babies with higher risk for DDH but lacks sensitivity. The renowned risk factors include positive family history, following breech delivery or with torticollis, and oligohydrominios. The early identification of children with DDH is valuable as it allows for less invasive treatment than if DDH is identified late [1]. However, the benefit of screening all children with ultrasonography is still controversial in literature.

Controversy persists in the literature as to a potential association between idiopathic structural congenital talipes equinovarus (CTEV) foot deformity of the newborn and developmental dysplasia of the hip (DDH). Several studies have shown increased incidence of DDH in children with CTEV [2,3], whereas other studies have challenged that view suggesting that routine screening for DDH in cases of idiopathic CTEV is no longer advocated [4-6]. Hence, there remains a debate about the true association between CTEV and DDH.

We encounter patients from diverse ethnicity at Hamad General Hospital. We have followed all these patients that were referred to orthopedic service with an obvious clubfoot deformity with ultrasound screening of hips for 2 years. This observational cohort study was performed to assess if selective radiographic screening of hips in the clubfoot population is beneficial or not.

Materials and Methods

The study was conducted at Hamad General Hospital, Doha, Qatar. All cases of neonatal CTEV that were referred to the pediatric orthopedic service for evaluation in our hospital underwent routine clinical and ultrasound screening of the hips [7].

CTEV was diagnosed clinically based on the classical appearance of a fixed deformity combining equinus at the ankle, varus at the heel, supination at the mid-foot and adductus at the forefoot. Although CTEV was graded according to Pirani classification, it was not used for further in the study.

All basic details about the child were recorded. These included the patient biographic details, family history, prematurity, method and mode of delivery, history of multiple pregnancies, whether there was any complication during the delivery, and if the child has any other anomalies than the clubfoot. Children with CTEV have their hips examined clinically, all neonates’ hips were clinically examined for instability at the initial visit using the Barlow and Ortolani tests and screened with ultrasound for DDH. Static sonography was performed at the initial visit and followed at 6 weeks. Those with normal hips were not followed further. All ultrasounds were performed by the senior orthopedic consultant. The degree of dysplasia was classified according to Graf. Hips with Graf angle > 60° were classified as normal (type I), from 43° - 60° as type II (‘A’ if under three months of age, ‘B’ if aged over three months), < 43° and stable as type III and a dislocated hip as type IV. All type IIA (physiologic) underwent repeat ultrasound after three months to see if the abnormality persisted. Treatment was warranted for all babies with Graf type III or higher. Type IIB hips were regularly followed up and none required treatment.

Babies were followed up for a minimum of 2 years. As in other studies seeking to clarify an association between DDH and CTEV, we excluded all neonates with postural foot deformities, genetic syndromes or neuromuscular disorder, even though children with CTEV and DDH may have an underlying as yet undiagnosed syndrome.

Result

50 cases of congenital talipes equinovarus were referred to the orthopedic service during the study period and thus screened for hip dysplasia. There were 13 girls (26%) and 37 boys (74%). There were 18 cases (36%) of bilateral CTEV, 17 (34%) were left sided and 15 (30%) right sided.

Of the total 50 patients, 22 (44%) belonged to the local community (Qatari) whereas the rest were from varied backgrounds. 37 babies (74%) had spontaneous vaginal delivery (SVD). Of these, none was a breech presentation. 13 babies (26%) had caesarian section as method of delivery. 3 out of these 13 (23%) had breech presentation although none of these had a dysplastic hip. 2 babies were born prematurely at 32 and 33 weeks. None of the families had history of DDH previously, although 2 babies had their elder siblings that suffered from clubfoot.

1 female child had dislocated hip on the right side (Graf type IV). She underwent management for CTEV and DDH and was followed for 3 years before she travelled abroad for further treatment. 2 male babies had bilateral dysplastic hip (Graf type III) while 2 male babies had a unilateral DDH (Graf type IIA) – (1 had a left sided clubfoot and a left sided DDH; the other had bilateral clubfoot but DDH on the right side only). These last two cases were followed and had their hip ultrasound done after 3 months and instigated treatment. All babies with Graf III or less were successfully treated with Pavlik harness without complications.

According to the findings 5 babies out of 50 with no other risk factors for DDH with CTEV had dysplastic hip diagnosed upon ultrasound screening. That is every 10th child of 100 births (10%) with congenital talipoequinovarus suffers from developmental dysplasia of hip.

Discussion

There is controversy in the literature regarding the association between CTEV and DDH and there is still debate about the true association between both conditions. Studies to date have shown a variation in the incidence of DDH in children with CTEV, but no consensus has been reached. RW Paton et al in a 21-year prospective observational study included 139 children with 199 cases of fixed idiopathic CTEV feet. Sonographically, there were only 18 hips with Graf Type II hips, 1 Graf Type III hip and 0 Graf Type IV hip [8]. Westberry et al looked at 349 babies with idiopathic CTEV. 127 had screening hip radiographs identifying 1 with hip dysplasia. 1 in 127 (0.7%) [9]. Recently, T Ibrahim et al in a systematic review and meta-analysis found that the prevalence of DDH in idiopathic clubfoot is similar to the normal population, based on that they did not recommend routine screening for DDH in children with idiopathic clubfoot [10].

On the other hand, the results from some other studies have suggested an association between clubfoot and DDH. BT Carney identified eight children (16%) with radiographic signs of hip dysplasia among fifty-one children with clubfoot [11]. D Zhao et al in an observational cohort study over a three-year period revealed that the idiopathic CTEV group had a greater incidence of DDH in comparison with the general population, 2.7 % of babies (five of 184) with idiopathic CTEV had DDH [12]. DC Perry et.al in an observational cohort study identified seven babies with hip dysplasia among 119 babies with CTEV, which means 1 in 17 babies with CTEV will have underlying hip dysplasia, supporting selective ultrasound screening of hips in infants with CTEV [13].

Ultrasound of the hip has a high sensitivity for the diagnosis of DDH compared with pelvic radiographs and clinical examination and has become the most effective modality for early detection of DDH. It is widely accepted that DDH identified at an early stage in infancy requires less invasive treatment than when presenting later [1]. Although, there is a controversy if early ultrasonography should be performed for the diagnosis of DDH in all babies, most studies recommend selective screening in high-risk population, including those with a positive family history, following breech delivery or with torticollis, oligohydramnios and deformities of the foot [9]. Several authors have considered children with idiopathic clubfoot as a defined subgroup of the population with an increased risk of DDH and recommend selective ultrasound hip screening [13].

According to unpublished data, incidence of DDH in our population is 8/1000 live births, in our study 3 out of 50 babies with CTEV have DDH (Hips with Graf type IIa were considered as physiologic immature and were not included). In other words, incidence of DDH in babies with CTEV is 6/100 live births. This figure suggests that our CTEV group has 7.5 times greater incidence of DDH than the normal population.

We have to acknowledge that this study has certain limitations. Small sample size which is due to the rare nature of these two conditions. Our study did not include a control group as ethical restriction prevented direct comparison to a control group (Table 1&2).

Table 1: Degree of dysplasia classified according to side of CTEV.

Table 2: Degree of dysplasia using the Graf classification.

Conclusion

Based on our study results, a higher incidence of DDH exists in the population of our patients with idiopathic CTEV and it appears that CTEV remains an important group for selective ultrasound hip screening. However, studies of good quality with a larger sample size to assess the association between the CTEV and DDH would be most appropriate next step.

Acknowledgement

This research was conducted after the approval from Medical Research Center (MRC) at HMC. We acknowledge the support from MRC throughout the study. None of the authors of the study have any other financial benefits associated with the study.

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