1.7 Clubfoot

One of the most common deformities of the lower extremity is clubfoot. This deformity is characterized by plantar flexion or dorsiflexion and inversion or eversion of the foot. The clubfoot deformity, if not corrected, would force the individual to walk on the side of the foot or on the ankle rather than on the sole of the foot.

This defect can be acquired or congenital. The ac­quired type of clubfoot can develop from a spastic paralysis, as in cerebral palsy or other neuromuscular diseases, which may eventuate in bone and soft tissue changes.

Medical Treatment. If the deformity is recognized soon after birth, a plas­ter cast is employed to retain the foot in an overcorrected position. Special clubfoot shoes with a rigid steel pole may be employed for the prewalker to help maintain the proper position of the foot. Various corrective shoes may be worn and splints applied to continue the development of proper foot alignment until amelioration is achieved.

The pupils limitations and capabilities will depend on the extent of residual derangement and deformity. A handicapped child with a severe malformation may be restricted from standing for long periods or may be unable to walk without fatigue. Activities requiring running and jumping must be modified. Team and individual sports activities are beneficial for the pupil with clubfoot, but they have to be adapted to prevent the deleterious effects of extensive running, jumping, and kicking.

Therapeutic Treatment. Exercise cannot be considered a means for correct­ing a clubfoot. However, a graded program should be given to the pupil that will maintain or improve muscle tone, ambulation, body mechanics, posture and physical and motor fitness.

1.8 Arthrogryposis (curved joints)

Arthrogryposis is a condition of flexure or contracture of joints (joints of the lower limbs more often than joints of the upper limbs). When several limbs are in contracture, the condition is referred to as multiple congenital contracture.

The limbs may be fixed in any position. However, un­usual forms are with the shoulders turned in, elbow straightened and extended, forearms turned with the palm outward (pronated), and wrists flexed and deviated upward with the fingers curled into the palm. The hips may be bent in a flexed position and turned outward (externally rotated), and the feel are usually turned inward and downward. The spine often evidences scoliosis, the limbs are small in circumference, and the joints appear large and have lost their range of motion.

Several physical conditions are associated with arthrogryposis, including congenital heart disease, urinary tract abnormalities, respiratory problems, at dominal hernias, and facial abnormalities. Children with arthrogryposis may walk independently but with an abnormal gait, or they may depend on a wheel­chair.

Medical Treatment. Surgery is often used to correct hip conditions as well as knee and foot deformities and is sometimes used to permit limited flexion of the elbow joint as well as greater wrist mobility.

The awkwardness of joint positions and mechanics causes no pain, and therefore children with arthrogryposis are free to engage in most types of activity.