a. Clubfoot is one of the most common disorders of the lower extremities.

It is marked primarily by a deformed talus and shortened Achilles tendon that gives the foot a characteristic club like appearance (see figure 11-7). Clubfoot may be associated with other birth defects such as myelomeningocele.

(1) Shortened Achilles tendon.

(2) Calf muscles may be shortened and underdeveloped.

(3) Foot is tight in its deformed position and resists manual efforts to push it back into its normal position.

(4) Painless.

c. Treatment is administered in three stages: Correcting the deformity, maintaining the correction until the foot regains normal muscle balance, and observing the foot several years to prevent the deformity from recurring.

The ideal time to begin treatment is during the first few days and weeks of life.

(1) Manipulation of the foot/feet and casting. A plaster of Paris cast is applied from the groin with the knee flexed. Once the deformity is fully corrected, the foot is held in an over corrected position in a solid cast for three to six weeks.

(2) Exercise. Passive stretching exercises are done to manipulate the foot/feet into normal position.

(3) Night splints . The Denis Brown splint is composed of a flexible horizontal bar that is attached to a pair of foot plates. The infant’s feet are attached to foot plates and positioning the abduction bar and the foot plates controls the desired position of the foot.

(4) Orthopedic shoes . Orthopedic shoes may be worn during the day or as necessary.

(5) Surgery. Resistant clubfoot may require surgery.

d. Nursing intervention.

(1) Be able to recognize clubfoot as early as possible. This is of primary concern.

(2) Stress the importance of prompt treatment to parents.

(3) Care for the cast.