Bilateral equino virus

Follow up after one year showed that the child could walk with apparently normal gait and there was no residual deformity. There is need for more enlightenment on the importance of early referral of CTEV cases for Physiotherapy care. Talipes equino varus is a derivative from Latin: talus ankle and pes foot ; equinus horse-like , that is, the heel in plantar flexion and varus-inverted and adducted 2. Hence the deformity comprises of three elements visa-viz: Inversion twisting inward of the foot, adduction inward deviation of the forefoot relative to the hindfoot and equinus plantar flexion 3.

Historically, talipes equino varus was recognized and documented since the time of the ancient Egyptians 2 , 4. Hippocrates introduced talipes equinovarus into the medical literature in BC 5 , 6. The incidence of CCF varies widely with race and sex. World wide, it is estimated at 1 to 2 per 1, live births 7 , 8. In the United States the incidence is about 2. In unilateral cases, right side affectation dominates A positive family history has been connected to high incidence 6 , According to Strach 5 , Hippocrates had suggested that the treatment of CTEV should start as soon as possible after birth with repeated manipulation and fixations by strong bandages which should be maintained for a long time to achieve over correction.

This sage's teaching principles of treatment are as valid as they were over 2, years ago 2. Presently management of CTEV is fraught with controversy hence there is no consensus as to the best treatment for this deformity Sometimes they prefer to wait until when the child is old enough before management can commence.

In view of this, this study presents a case report of a 2-day old baby boy with congenital talipes equinovarus managed conservatively using physical therapy. A 2-day old baby boy who weighed 3. The baby was delivered at full term, by spontaneous vaginal delivery SVD in a missionary hospital. On examination, the baby was found to have bilateral congenital talipes equinovarus figure 1.

Both feet were noticed to turn inwards with the soles directed medially, giving a bow string appearance at both ankle regions. The right foot was observed to be more affected than the left. The characteristics features of CTEV, that is, a three dimensional deformity inversion, adduction and equinus with four components C. E were evident in both feet visa viz:.

Infant at presentation 48 hours after birth with bilateral congenital talipes equinovarus. On passive movement, there was relative tightness of the tendoachilles on both ankles the right more than the left ; the talocrural, the subtaloid and the mid-tarsal joints were stiff.

Every other part of the musculoskeletal system was clinically normal. The goal of management of the baby consisted of short term and long term goals. The short term goal was to correct the deformity so that the ankles assume plantigrade position by the time the baby would be three months old. The long term goal was to maintain the corrected ankle in situ and follow up the maintained correction until the baby starts walking and if feasible further follow up to avoid relapse.

Rhythmic and repeated gentle manipulation Strapping 14 and plaster of Paris POP cast The right foot which was more affected was first attended to. Thereafter the soft tissues of the right foot were passively stretched as follows: the forefoot was uncurled so that it moved away from the ipsilateral heel that is forefoot abduction. This manoeuvre was to correct adduction. Then the foot was turned such that the sole faced outward that is eversion , in an attempt to correct the inverted foot.

Finally, to correct the equinus plantar flexion deformity , the heel was cupped with the right hand from the front of the foot and an upward pressure was applied to it bringing the forefoot upward. This brought the ankle into dorsiflexion.

Each of the above manipulation lasted for about two minutes and the entire procedure was repeated four times. The baby was allowed to rest for about 20 minutes while the mother breast fed him.

Then the same manoeuvre and procedure were performed on the left. To maintain the feet in the corrected position, strapping was commenced. Materials needed for the strapping were: a 2. Before strapping commenced, skin toileting was religiously observed as follows: the hands were washed with medicated soap and distilled water, then dried with sterilized towel.

Finger nails were always cut and kept clean. One of the authors stabilized the baby's limb and the other carried out the procedure. Thereafter tincture of benzoin compound TBC was applied to prevent skin excoriation and improve the adherence of the plaster so that hairs would not stick to the straps.

Scissors was used to cut the 2. Strapping began by holding the manipulated right foot to over corrected position. This was to correct the heel varus deformity. This was important to correct the varus and equinus deformities by eversion of the foot and abduction of the forefoot.

The last strip was applied circumferentially around the leg at a point 2cm above the ankle joint. The baby rested, then the left foot underwent the same process figure 2. At the end of the procedure the mother was asked to wait for 30 minutes while breastfeeding the baby. This was to observe for any compromise to circulation. For the first six weeks the baby was seen thrice a week and strapping applied twice per week.

From the period the baby was 7 to 12 weeks, he was being seen two times in a week and the strapping was done once per week. At three months there was marked improvement, especially on the left foot figure 3. By this period that is when the baby was three months , the strapping was no more effective because he was kicking vigorously with the lower limbs. The plaster was changed weekly for the first eight weeks of application and the knees and feet mobilized on each occasion.

Thereafter it was applied and changed forth-nightly for another eight weeks. However, there is a familial tendency noted passed down from the biologic family through genes. There are also many associated disorders or syndromes such as developmental hip dysplasia, spina bifida, arthrogryposis, or myotonic dystrophy. The pediatric orthopedist will take a full history and perform a thorough exam to determine if any other testing or referrals are necessary at the first visit.

This foot abnormality can be multi-factorial in nature, meaning there could be several different pre-disposing factors. Many times, the diagnosis of clubfoot can be noted during a prenatal ultrasound. However, the severity of it cannot be determined until after the child is examined and there is no treatment until after the child is born.

If the orthopedist feels a child has a clubfoot associated with another condition or syndrome or there are associated findings, the care-givers will be given an explanation with orthopedic treatment if needed and a referral to another specialist as needed. In the past, very few treatments were available to correct this condition.

Over the last century, advances have been made in non-operative treatments, such as casting and bracing as well in surgical techniques. Current treatment consists of casting and bracing or a combination of casting, bracing and surgery. Ignacio Ponseti developed the Ponseti method for treatment of clubfeet over 60 years ago. The tight heel cord may respond well to stretching in casts. Some physicians perform this in an orthopedist office with local anesthesia such as lidocaine , but most of the surgeons at Nationwide Children's Hospital complete this in the operating room under general anesthesia fully asleep.

The procedure typically takes 15 minutes. A small nick is made in the skin along the crease above the heel bone. This nick will heal with a very tiny scar. The tendon is found and a small cut is made through the tendon to allow it to stretch and lengthen.

By lengthening the heel cord, the heel is able to drop down and align correctly for normal standing. After this procedure, the infant will be placed back into a cast for weeks before transitioning into special shoes and a brace. Once the casting is completed, the child will be transitioned into a set of special shoes to keep the foot in correct alignment. This next step in the treatment process is the longest and most important. The special pair of shoes with a bar attached at the bottom will be made for the baby.

These are called Denis-Browne Shoes and Bar and they are fit at an orthotist office. The bar, not the shoes, is the main workhorse of this treatment and must be used at all times. At this point, the shoes will be used during naps and bedtime 12 hours a day. This routine will be maintained until the child is 4 to 5 years old or older.

If the shoes and bar are worn correctly, as instructed by your doctor, larger, more invasive surgeries can be avoided. Without proper follow-up, the deformity will likely reoccur. Horses with both EqPV-H and EqHV can be healthy carriers with no clinical signs, and could serve as reservoirs for infection of other horses. The recent report by Divers et al. Two other articles have been accepted for publication in the Journal of Veterinary Internal Medicine:.