Clubfoot

Clubfoot is a congenital condition that affects newborn infants.The medical term for clubfoot is Congenital Talipes Equinovarus. This condition has been described in medical literature since the ancient Egyptians. Congenital means that the condition is present at birth and occurred during fetal development. The condition is not rare and the incidence varies widely among different races. In the Caucasian population, about one in a thousand infants are born with a clubfoot. In Japan, the numbers are one in two thousand and in some races in the South Pacific it can be as high as seven infants in one thousand who are born with a clubfoot. The condition affects both feet in about half of the infants born with clubfoot. Clubfoot affects twice as many males as females. 

How does this problem develop?

During the nine months of pregnancy, the fetus undergoes remarkable changes. In the skeleton, these changes include the separation of each individual bone in the body from one mass of bone material. In some cases, this process is flawed. A clubfoot occurs when this failure of separation occurs in the tarsal bones of the foot.

Until recently, most experts believed that the clubfoot deformity was due to the foot being stuck in the wrong position in the womb. As development progressed, the foot could not grow normally because it was turned under and held in that position. Today, most information suggests that clubfoot is hereditary, meaning that it runs in families. It is not clear what genetic defect causes the problem. It is not known yet whether the defect affects the development of the muscles, blood vessels, or bones of the foot.

What treatment options are available?

Treatment for clubfoot usually begins at birth. Treatment in the majority of infants will require both non-surgical treatment and surgery. The foot will never be normal, but treatment can provide a very functional foot that can be used for walking without pain.

Nonsurgical Treatment

The most commonly used non-surgical treatment in the newborn and infant is manipulation and casting. This is started as soon as possible. The foot is manipulated to stretch and loosen the tight structures. The foot is then placed in a cast to hold it in a corrected position. This is repeated every one or two weeks until the deformity is corrected or surgery is performed.

As any parent knows, the newborn grows rapidly after birth. The technique of manipulation and casting the foot is used to guide the growth of the foot towards the normal alignment. Without this guidance, the foot will remain deformed and may actually get worse. The greatest chance for correction of deformity occurs early in life when there is so much growth occurring.

There have been many different techniques proposed for the way the foot is manipulated and the way the casts are applied. Treatment of the infant with clubfoot is definitely one of the arts of medicine. Successful treatment requires patience and attention to detail.
The success of treatment of clubfoot by manipulation and casting alone varies greatly. The majority of infants will eventually require surgery but the manipulation and casting begins the process of guiding the foot towards a more normal form. In the infant that eventually needs surgery, the manipulation and casting are still required to obtain as much correction as possible prior to the surgery.

What should be expected from treatment?
Physiotherapy  after surgery for a clubfoot can begin as soon as your child’s surgeon recommends it.  All treatment, either surgical or non-surgical including physiotherapy, is designed to give the child a foot that can be placed flat on the floor. Another goal of therapy is to assist your child’s walking biomechanics in order to encourage your child to walk as efficiently as possible. Lastly, our goals also include relieving any pain if present, preventing pain in the future, maintaining the flexibility of your child’s muscles and tissues, and preventing any weaknesses around the lower extremities and core from developing.

During your first appointment your Physiotherapist will discuss your child’s foot brace with you and ensure that you are confident putting it on and taking it off.  Your doctor will set the specifications of the brace according to your child’s needs. Your doctor will inform you which activities are safe while in the brace and which ones should be avoided.

The schedule of how long your child will have to wear the brace each day will be set by your child’s surgeon.  At first the time with the brace on will likely need to be most of the day and night. Generally the wearing time is gradually decreased over time so that your child has some awake time without the brace on. In most cases children will need to wear the brace during all sleep times until eventually sleep time is the only time the child is required to wear the brace. Depending on the age of your child, once the brace is discarded during the day, your physiotherapist may incorporate taping techniques of the foot to provide gentle foot positioning guidance.

Your physiotherapist may address any pain issues that your child may be experiencing from the surgical procedure or the deformity itself, depending on the age of your child. Your physiotherapist may use modalities such as ice, heat or massage to try to relieve any pain. In some cases they may even use ultrasound, again depending on your child’s age and the location of their pain.

Maintaining the length of the tissues in your child’s foot is the main goal of any stretching exercises we do with your child or ask you to do with them.  Your child’s age at the time of surgery will largely influence how formal the stretches and strengthening exercises for your child will be. If they are old enough to understand and follow along, your physiotherapist may encourage specific stretches for the back of the calf and Achilles tendon, as well as for the bottom of the foot.  Often, however, children who have had surgery for clubfoot are too young to effectively engage in formal stretches therefore play activities that encourage these types of stretches will be taught.  Ensuring that your child spends time squatting, standing with feet flat, standing on their toes, standing on their heels, walking without the brace, and practicing jumping are ways to encourage proper foot movement. Your physiotherapist will guide you through which of the activities are most important for your child at which time, the proper technique for these activities, and how long they should be performing each activity. 

 You will be taught by your therapist how to apply pressure properly to your child’s foot or leg during these activities in order to encourage normal foot alignment.  If your child is too young to walk or do the higher level activities then your physiotherapist will teach you age-appropriate play activities that encourage the proper positioning of your child’s foot and lower leg.  Range of movement exercises that encourage motion of the foot in all directions away from the clubfoot position will be important.  Of particular importance are passive Achilles tendon stretches, which will be taught to you and will be encouraged frequently.  The Achilles tendon is the thick tendon at the back of the ankle. 

Maintaining the length of the Achilles tendon after casting and surgery to lengthen it prepares the foot and ankle to take the body’s weight for activities such as walking, squatting, and jumping.  It should be noted how important it is to maximize use of the time that your child spends outside of the brace by doing the specified activities that your physiotherapist prescribes as this will train the muscles to hold your child’s new foot position and give the other tissues as much active stretching as possible.  

Formal strengthening exercises for older children will be taught which encourage ankle, calf, hip, and core strengthening as well strengthening for the muscles that pull the foot into a position where the sole of the foot is turned up and out (opposite to the clubbed foot position.) As previously mentioned often the child who has had surgery for clubfeet is too young to perform any formal exercises. Playing is once again the best method to encourage strength development in your child’s feet, legs and core area.

Your physiotherapist will encourage fun play activities and games such as assisted frog jumps or hops on one leg in order to strengthen the appropriate muscles.  Even helping the young child mimic these types of activities can be very useful to strengthen the legs and feet and encourage proper foot position. Any activity they enjoy which encourages the proper motion is useful! Often singing while doing activities or making a game of the exercises is the best method of incorporating rehabilitation into your young child’s world.

Generally children who have had surgery for clubfeet do extremely well with the physiotherapy.  Over the course of your child’s therapy your therapist will liaise closely with your child’s doctor, surgeon, Orthotist, and Podiatrist as well as any other health care professionals that are involved in their care to ensure your child is recovering as quickly and normally as possible.

Starting over

Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending. – Carl Bard

Let our physiotherapists help you with your brand new start, and achieve your rehabilitation goals for a new and active lifestyle.

We can help you  http://www.physionam.com/index.html?id=02

The Role of Physiotherapy for Back Pain

Back pain can slow you down and even stop you in your tracks. If you’ve suffered from back pain – whether from an acute injury or chronic strain– you’ve probably tried many approaches and gotten a lot of different advice on how to make it better.  Some people only consider physiotherapy after they’ve gone through a laundry list of home remedies, but physiotherapy can make a difference regardless of what stage of back pain you are in right now. Even if the source of your chronic pain hasn’t been identified, physiotherapy can help you get back to doing what you love and keep you from missing work.But shouldn’t I just be resting until I feel better? Although this depends on the exact nature and severity of your pain, most physiotherapists – anywhere in the world – will try to avoid putting you on bed rest or otherwise immobilizing you for longer than a few days. Bed rest may be helpful to get through the first day or two after an injury, but a review of multiple studies suggests there is no difference whatsoever in pain or function between staying active and staying in bed, even just one week after the pain starts.When it comes to pain that isn’t related to a specific injury, not only is long-term bed rest impractical, it also isn’t helpful: for sciatica patients, the benefits of bed rest are negligible after two weeks, no better than simply going about your business and being mindful about your back.

What will be doing?

 

Physiotherapist we will probably combine multiple approaches in treating you, because everyone is different and requires different care. Most likely, the care you receive will involve or more of these activities:  Stretching and strengthening exercises;  Soft tissue massage and manual therapy;  Applying heat or cold to affected area;  Traction & Dry Needling (if needed);  Posture correction ;  3D Consultation;  Work Ergonomics

What if I don’t like doing the exercises?

Your active participation is a very important part of getting better and staying in the game of life.Your physiotherapist is your coach and will pick exercises for you designed to improve your body’s function, and some may be uncomfortable when you first do them.This may make you want to stop your treatment, but there is good evidence that working with this pain – under the direction of your physiotherapist – will get you through to a future with less pain. This is why it’s key to stick to your routine and see your treatment through to the end, keeping your physiotherapist informed of how things feel as you progress so that the exercises can be adapted if need be.that’s a good thing.There has even been a study showing that physiotherapy is just as effective a treatment for back pain whether or not you agree with your physiotherapist all of the time.Everyone has their own opinions on how to manage their own health, and your Physiotherapist will work with you to help get you back to what you want to be doing.

What if I don’t like doing the exercises?

Your active participation is a very important part of getting better and staying in the game of life.Your physiotherapist is your coach and will pick exercises for you designed to improve your body’s function, and some may be uncomfortable when you first do them.This may make you want to stop your treatment, but there is good evidence that working with this pain – under the direction of your physiotherapist – will get you through to a future with less pain. This is why it’s key to stick to your routine and see your treatment through to the end, keeping your physiotherapist informed of how things feel as you progress so that the exercises can be adapted if need be.Everyone has their own opinions on how to manage their own health, and that’s a good thing. There has been more than one study proving that Physiotherapy is just as effective a treatment for back pain whether or not you agree with your physiotherapist all of the time.

How can I get started?

If you’re ready to consider adding a Physiotherapy service to your fight against back pain, come and speak with one of the trained physiotherapists in Namibia. We would love to help you get back to your regular life, and we are ready to listen and work with you on a personalized approach.

History of Physiotherapy  

   If one goes back in time, you will find forms of physiotherapy used centuries ago. Hippocrates advocated massage and Hector used hydrotherapy (water therapy) in 460 B.C.

The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling, “Father of Swedish Gymnastics,” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. 

 The word Physical therapist is a Swedish word       “sjukgymnast” = “sick-gymnast.” Modern physical therapy was established to the end of the 19th century in Britain.  

After American orthopedic surgeons began treating children with disabilities they began employing women trained in fields of physical education, massage, and remedial exercise. These treatments were promoted further during the Polio outbreak of 1916. During the First World War women were recruited to work with and restore physical function to injured soldiers, and the field of physical therapy was institutionalized.

The first school of physical therapy was established at Walter Reed Army Hospital in Washington D.C. following the outbreak of World War I.  The first physical therapy research was published March 1921 in “The PT Review"-United States.   Treatment in 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, in the early 1950s.

Later that decade, physical therapists started to move beyond hospital-based practice to outpatient orthopedic clinics, public schools, colleges/universities, geriatric settings (skilled nursing facilities), rehabilitation centers and medical centers.

Physical therapy in the U.S. was more specialized as form 1974.

Now we know where our profession originated from. I think we are lucky, to be able to 

to be medical professionals in our modern era with technology and a lot of evidenced based research at our finger tips. Just so much more we can do to help our patients. 

FIRST POST

I'm a medical professional with a passion for life and people.  As Physiotherapist and Multiple Practice owner in Namibia, I've come to realize that my patients are always looking for trustable advise and medical information with regards to their:  Injuries & Conditions, Sport- & Work Activities,  as well as their General Health. 

The aim of my blog will be to supply my readers with not only medical facts based on research, but I will also be sharing knowledge through personal experience gained over the last seven years of my career.  I will keep readers up to date with local sport events and also share our involvement within our local community.

I will make posts and share personal and interesting discovered information, articles, videos, and photos at least once,  every second week. All readers can reach me via my Webpage, Facebook, Twitter or my personal Email Adress: physio@iway.na. It will be great if other medical professionals and members of the public can leave comments and share their experiences and knowledge. 

As Medical Professionals we should focus on giving back to the community and making a positive difference in people's life's.

Your's in Health

Anna-Mart Kruger