pathology: clubfoot

yogabook / pathologie / clubfoot

clubfoot (pes varus / pes equinovarus congenitus)

Definition of

Severe foot deformity caused by a muscle imbalance in which plantar flexors and supinators predominate. Clubfoot is rarely congenital (primary); it is usually the result of damage to nerves, muscles and tendons caused by trauma or disease (secondary). It usually has serious consequences for the musculoskeletal system with arthrosis, pain and loss of quality of life. Clubfoot varies from person to person and is usually made up of the following deformities:

  1. Hindfoot varus
  2. Pointed foot (pes equinus) with an inability to rest the heel on the ground, the talocrural joint remains in plantar flexion
  3. Sickle foot (pes adductus): Forefoot and midfoot are strongly bent inwards and supinated, i.e. the medial edge of the foot is raised
  4. Hollow foot (pes excavatus): excessively pronounced longitudinal arch of the foot without contact between the midfoot and the ground
  5. In addition, altered shapes of individual foot bones occur
  6. Ligament or muscle damage prevents the foot from functioning physiologically

Frequency: 1-2/1000 (about 1:800), M:W 2:1. Although boys are more frequently affected, the deformity is more pronounced and more difficult to correct in girls. Congenital clubfoot is often associated with: pointed foot (inability to put the heel up), sickle foot, hollow foot, bow legs

ICD Q66.0

Cause

  1. Congenital (various etiologies, including lack of space during fetal development)
  2. Neurogenically acquired (impaired enervation and weakening of the fibularis longus and fibularis brevis), predominance of the posterior tibialis
  3. flaccid and spastic paralysis
  4. Injuries: Consequence of compartment syndrome, injury to fibularis tendons
  5. Consequence of severe trauma with fractures
  6. Circulatory disorders
  7. Burns with contractions of the skin
  8. iatrogenic: surgical overcorrection of other foot deformities

Predisposing

  1. familial accumulation
  2. Smoking during pregnancy
  3. Various ethnic groups have an increased risk
  4. Diabetes mellitus can lead to damage to the hindfoot and thus later to clubfoot

Diagnosis

  1. neurological testing
  2. Gait pattern
  3. Analysis of existing movement restrictions and malpositions
  4. Podometry/Podobarometry

Symptoms

  1. Various pain phenomena: joint pain, pressure pain, tendon pain
  2. Failure of the rolling motion of the foot
  3. Shortening of the Achilles tendon
  4. Combination of the following deformities:
  5. Supination or varus position of the hindfoot(pes varus, hindfoot varus)
  6. Sickle foot position of the forefoot (pes adductus)
  7. Pointed foot (Pes equinus)
  8. Splayfoot (pes supinatus)
  9. Hollow foot(Pes excavatus)

Complications

  1. Ankle arthrosis and arthrosis of various tarsal joints including the lower ankle joints
  2. Chronic restrictions in quality of life
  3. Chronic pain
  4. Progressive movement and flexibility restrictions
  5. very rare: Rolling over the back of the foot
  6. Claw toes

Therapy

  1. Congenital: Redression (plaster cast, splint), possibly surgery of all necessary structures at the age of three months
  2. Movement therapy
  3. Manual therapy
  4. customized shoes
  5. Training the relevant foot muscles, avoiding impact movements during sport
  6. Antiphogistics, analgesics if necessary
  7. If necessary, timely decision on surgical intervention, if necessary arthrodesis in the talocalcaneal, talonavicular and calcaneocuboid joint. Arthrodesis of the USG in particular relieves much of the pain, but costs little in terms of range of motion and is of little relevance to everyday life, as it mainly affects supination and pronation, which are less relevant in everyday life.

Asana practice and movement therapy

An important component is the restoration or development of pronation abilityin the ankles. There are very few postures for this. Malasana is particularly suitable for this, the closer the feet are together, the better. Depending on how low the ability to pronateis, the ankles should be held together with a belt to achieve the appropriate effect.

All types of stretching of the calf muscles must be practiced against the pointed foot component, both for the soleus, i.e. with the knee joint flexed, and for the gastrocnemius, i.e. with the knee joint extended. The greater the force exerted, the better (if tolerated). This means that asymmetrical postures, in which the extension only acts on one lower leg, are generally more favorable than symmetrical postures. In the same way, upright postures are more favorable than flat ones, unless the effectiveness is increased with tricks, such as lifting one leg in the dog position head down.

Stretching the foot muscles (especially the toe flexors) and the calf muscles can help to reduce the tension of the plantar fascia and the muscles that stretch it, thereby reducing the hollow foot component.

For general stability in the ankle and sufficiency of the ligament systems(fibularis longus and tibialis anterior or tibialis posterior and fibularis brevis and fibularis longus) of the ankle, the balance-type postures are of great benefit, both those standing on one leg such as vrksasana, 3rd warrior pose and those with a narrow physical base of support such as parivrtta trikonasana, parsvottanasana, parivrtta parsvakonasana without heel on the floor.

Asanas

  1. Asanas in 861: Stretching the supinators to improve the ability ofthe ankle to pronate
  2. Asanas in 851: Stretch for dorsiflexion of the ankle
  3. Asanas in 971: Stretching for (plantar) flexion of the toes