2yr OLD BABY WITH PAINLESS DEFORMITY OF FOOT (LEFT) :AT BIRTH

 CHEIF COMPLAINT: Painless deformity of left foot.

PATIENT HISTORY:A 2yr old male baby visited our hospital on 21/02/22 with painless twisted left foot.Father of patient is a farmer by occupation. The baby born with deformed foot at birth.The patient was active without any pain in the foot , apetite is normal . His parents took him to the hospital in Hyderabad at 5 months of age. Casting for foot is done on 25/5/20.6 castings are applied for 6-8weeks. But the deformity of foot was not lost completely .So the patient came to opd with twisted foot after discontinuing the casting procedure.

PERSONAL HISTORY:
• Patient has no loss of appetite
• Bladder movements are normal
• Bowels are regular
• No known allergies are seen
• achieved all the milestones


FAMILY HISTORY:
• There are no similar complaints are seen in the family members
• No such deformities are seen in any of the family members

TREATMENT HISTORY:
• Casting technique is done for 6-8weeks 
• No surgeries are done

GENERAL EXAMINATION:
• Patient is conscious, coherent and active at the time of joining
• pallor is seen
• No icterus
• No clubbing of fingers
• No edema of feet
• No cyanosis

VITALS
•Pulse rate:65 beats per min
•Bp:100/70mmhg
•Spo2:98%








SYSTEMIC EXAMINATION:
Cvs- 
• No thrills
• No cardiac murmers
Respiratory system-
• No dyspnea
• No wheeze
• Tracheal position is central
• Breath sounds vesicular
Abdomen-
• No tenderness
• No palpebral mass are seen
• Hernial orifices are normal
CNS-
• The patient is conscious and active 

DIAGNOSIS:

CTEV-Congenital talipes equinovarus /Club foot

TREATMENT:

POSTEROMEDIAL SOFT TISSUE RELEASE- Surgery
          Syp zincovit 5ml -1gm IV
          Syp pcm 4.5 ml - 4.5ml 
          Inj neomal
          Inj metrogy
          Inj metrocef

DISCUSSION:
CTEV is a condition in which new borns foot appear to be rotated internally at the ankle.The foot points down and inwards.This type of deformity is most common in bones and joints in newborns.
The cause of this condition is not exactly known. It may be due to genetic disorder or some other complications of mother such as less amniotic fluid .
In this condition, the new born tendons that connect leg muscles to heal are too short. These short tendons cause the foot to twist out of shape.
This type of conditions are more common in male children when compared to female children.
Genetics has a major role to play in this condition, children who either have one or both their parent who had condition at time of birth are more likely to suffer from this.


Treatment can be done by "ponseti casting technique",which is done in sessions .This process may be done 4 to 10 times using 4  to 10 new casts.If patient foot is not responded to this treatment surgery is done.
At the tym of birth ,the patient is fully able to live a normal active life, without pain and any discomfort.If left untreated ,it may lead to severe complications.


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