Baby's right foot turns inward

Many pregnant women will find that their babies have inversion of the right foot when doing four-dimensional color Doppler ultrasound during pregnancy, and at this time they will still insist on giving birth to the baby. Although inversion of the foot is a deformity, the current science and technology is relatively advanced. As long as the child is born, treatment can be started, and inversion of the foot can be cured. So what is the matter with inversion of the right foot?

Foot varus is a developmental deformity that can be found at birth and is caused by spasm of the tibialis posterior muscle. Foot inversion can occur in one or both feet. During the development process, the tendons and ligaments (posterior and deep) of the foot fail to develop in sync with the development of other tendons and ligaments in the foot. As a result, these tendons and ligaments pull the posterior and medial side of the foot downward, causing the foot to twist downward and inward. As a result, the bones of the foot are in abnormal positions, causing the foot to turn inward and become stiff and unable to return to its normal position.

Clinical manifestations

1. Unilateral or bilateral foot deformities of varying degrees occur after birth, with the feet showing plantar flexion, inversion, and adduction deformities.

2. When the child learns to walk, he or she walks with the forefoot or the outer edge of the foot. As the child grows older, the deformity becomes more severe. In severe cases, the child walks with the dorsum of the foot on the ground, and bursae and calluses appear in the weight-bearing areas.

3. X-ray film, anteroposterior and lateral view of the affected foot: After birth, the ossification centers of the talus, calcaneus, and cuboid bones can be seen on the X-ray film, and sometimes the third cuneiform bone can be seen. All metatarsal bones and phalanges have appeared, while the ossification center of the tarsonavitoid bone does not appear until the age of 3.

4. Estimation of deformity based on three lines:

1) Measure the heel-to-heel angle on the AP radiograph. If it is less than 30°, it indicates that the foot is not inverted.

2) Measure the angle between the longitudinal axis of the first metatarsal and the longitudinal axis of the talus, which is normally 0°-20°;

3) The lateral X-ray film measures the angle formed by the longitudinal axis of the talus and the plantar surface of the calcaneus. The normal angle is 35°-55°. If it is less than 30°, it indicates foot drop. If the talocereval angle is less than 15° and the angle formed by the intersection of the first metatarsal and the longitudinal axis of the talus is greater than 15°, it indicates a subluxation of the talonavicular joint (Simon's 15° rule).

Treatment principles

1. Start treatment after birth. The earlier the treatment, the better the effect. Treatment varies according to age and degree of deformity.

2. Manual correction method: generally suitable for children under 6 months or with milder cases. Start at birth, the earlier the better. The doctor teaches the mother or guides the child to first correct the adduction of the forefoot, then correct the inversion of the subtalar joint, and then correct the plantar flexion of the ankle joint. The technique should be gentle to avoid damaging the epiphysis. Hold each correction position for 10 seconds, for 10-15 minutes each time. The operation should be performed once a day, and it is generally recommended to be performed before breastfeeding.

3. Plaster tube external fixation correction: suitable for children aged 3 months to 1 year, replaced every 2-3 months.

4. Surgical treatment is suitable for those over 6 months old who cannot be corrected by manual manipulation. The procedure varies according to age. (1) Soft tissue release on the medial and posterior side of the foot is suitable for children aged 6 months to 6 years.

(2) Lateral column shortening is suitable for children over 3 years old with severe deformity. At the same time as the medial and posterior soft tissue release, the cuboid bone or calcaneal wedge resection of the calcaneocubital joint or the lateral wedge osteotomy of the calcaneus is performed.

(3) Triple arthrodesis is suitable for patients over 12 years old with severe deformity.