club foot and milestones development

[priyanaidu]

Iam treating a 18 months old girl who has bilateral congenital club feet right side better than left.She has been taking physiotherapy and occupational therapy right from the beginning.Her development milestones had been developing normally but unfortunately she started getting seizures which count atleast thrice a day for some time for which she has been taking medicines which had no effect.Then she been taking injections everyday for 15 days starting since two days back and these two days she did not have any seizures.She was given castings in the early stage and also was given club foot shoe later which she wore for only three months and then discontinued.Due to her seizures her milestones have been affected.she lost her speech ,her neck control is very weak has weakness in her right hand.She is also not able to come to sitting.She has no balance.I have seen her only yesterday and need some advise.Can i advice her club foot shoes at this point of time.I have started passive movements and stretching(mild) for both her feet.I do hamstring stretching and make her sit(longsitting)with back support and also support her head.She has not taken any physio for the past 2 months.

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[binmath]

hi ,
has any neuro imaging done to rule out serious diseases.i think the recent episodes of seizures might not be related to the congenital deformity.is there any obvious change in the eyes like sun setting sign,features of reduced sensation in the lower extremities and any spinal deviations.

[priyanaidu]

thanks for your reply.she does not have any other serious problems.she has no spinal deviations,no sunset sign,no loss of sensation in her lower limbs.the deformity is congenital and is not related to the seizures which developed some 15 days after birth.

[1234nale]

Hi,
Treatment for club feet should start ultra-early, in regard that your patients have 18 months you should see if it is structural (who have 2 forms-one flexible where shin is slightly hypotrophy and feet is normal length, where you can passively achieved partly correction; and resistant-where you have hypotrophy of shin short feet, small heel, subluxation or luxation of talo-navicular joint) or functional deformity? Then you could decide kind of treatment: physical treatment with use of orthotic measures (casts, shoes) or operative treatment- in this case by your question is most likely to be. The best time to estimate is it for conservative or for operative treatment is 6-12 weeks of life (that will do childe orthopedic surgeon with clinic evaluation or with X ray- earlier in 7 week of life).
This is in short for congenital deformity club feet, but it is look like that she’s having bigger problem then this, with seizures, sitting and head control, probably in some form of central damage. If you are treating only congenital deformity you could seek for orthopedic surgeon opinion.

[priyanaidu]

Thanks for your reply. Iam treating the child for improving head control,balance ,sitting ,hand grip and everything else along with her congenital bilateral club foot.The childs foot is rigid on her left but very slightly mobile on her right(Though she has been on physio till 3 months back).The doctors had advised her both foot to be operated when the child was born.Her parents are waiting for her seizures to be controlled first for which she is taking injections.Can I advise her for clubfoot shoes to both her feet till she gets operated.