Common hip and foot abnormalities

Two of the most common challenges relating to hip and foot abnormalities in newborns are developmental hip dysplasia and congenital talipes equinovarus.

Developmental hip dysplasia or congenital hip dysplasia is a common orthopaedic condition in newborns. In Caucasians, approximately one child in 1 000 is born with a dislocated hip (Westacott, Pattinson & Cooke, 2012). As we already discussed in Week 1, Congenital hip dysplasia occurs because the ‘ball and socket’ of the hip joint does not form properly. The head of the femur (thigh bone) is dislocated or is able to slide out from the hip socket, known as the acetabulum (Westacott et al., 2012).

If this problem is not corrected there is a risk that the hip won’t develop correctly. This may lead to pain, problems with walking, risk of arthritis and early need for hip replacement (Westacott et al., 2012). This problem is usually detected following clinical examination by the Paediatrician or specialist paediatric nurse, who is familiar with performing the Barlow and Ortolani manoeuvres we discussed in Week 1. The condition is further confirmed with a hip ultrasound (Westacott et al., 2012).

Initial treatment of congenital hip dysplasia uses a splint to place the infant’s legs in a flexed and abducted position. A variety of splints may be applied by the paediatric orthopaedic specialist, including the Pavlik harness or the Von Rosen Splint.

Congenital talipes equinovarus

This is a congenital abnormality of the newborn foot. The term Talipes Equinovarus is derived from the Latin words:

talus – which means ankle

pes – referring to the foot

equinus – which refers to plantar flexion or horse-like positioning of the foot (where the foot is lower than the heel) and

varus – which means the inward turn of the foot (Forster & Fraser, 2007).

Newborns with talipes equinovarus will usually have:

• turning inwards of the forefoot and heel
• downward pointing of the foot
• supination or upward rotation of the foot
• a smaller sized foot and small heel that is drawn upwards
• limited range of motion of the ankle
• a skin crease behind the ankle joint and along the foot’s medial plantar border
• contracture or shortening and tightening and weakness of the lower leg muscles
• under-developed calf muscle (Forster & Fraser, 2007)

Congenital talipes equinovarus is also known as Club Foot.©Shutterstock

In some cases, talipes equinovarus will be ‘postural’ and arising from the position of the baby in the womb. For example, when there is crowding within the womb in the case of multiple pregnancies. In these cases, even though the foot may appear to be the congenital talipes equinovarus, it can often be manipulated into a normal position and there is usually no skin crease or calf and leg muscle atrophy (Forster & Fraser, 2007).

Postural cases usually only require physiotherapy and splinting to correct the problem. True cases of talipes equinovarus will require plaster casting in the newborn period followed by splinting with specialised orthopaedic boots, and possibly surgical intervention (Forster & Fraser, 2007).

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References

Forster, E.M. & Fraser, J.A. (2007). Turning around Talipes: Nursing considerations. Neonatal, Paediatric and Child Health Nursing, 10(1), 27-32.

Westacott, D., Pattison, G. & Cooke, S. (2012). Developmental dysplasia of the hip. Community Practitioner, 85(11), 42-44.