PREFERRED PRACTICE PATTERN
4B: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Impaired Posture1
While hospitalized, a 3-day-old infant is referred to physical therapy with a diagnosis of myelomeningocele. The infant was diagnosed in utero and subsequently, delivered by caesarean section. Surgical reduction of the meningocele occurred within the first 24 hours. Post-op precautions include no positioning in supine. The infant is being monitored to determine if a ventroperitoneal shunt will be needed. Upon examination, the therapist notes bilateral talipes equinovarus with the feet postured in plantar flexion, inversion, and abduction. The physical therapist provides passive range of motion to the feet and ankles and instructs the parents on how to complete this activity as part of the home exercise program.
Idiopathic, though can be hereditary
Associated with syndromes such as arthrogryposis and Larsen syndrome3
Postural or positional; not a true club foot
Two categories: Flexible or rigid
Results from abnormally shaped tarsal bones that cause ligament and joint changes
Often associated with myelomeningocele4
May result from arthrogryposis
Deformities of the foot. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Incidence 1 to 2 per 1000 infants
2:1 male–female ratio
Hispanics at greater risk
Asians at least risk
Occurs most often in first-born infants
Clinical appearance of congenital right club foot. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
SIGNS AND SYMPTOMS
Either flexible or rigid deformities of the foot including plantar flexion, adduction, and inversion
Contracted intrinsic muscles of the foot
Possible Contributing Causes
Genetic: Siblings 30 times more likely to also have club foot
Environmental: In utero complications, such as too little ...
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