What is clubfoot?
Clubfoot is a congenital deformity, i.e. present at birth. It affects the foot and/or ankle. In patients with clubfoot, the bones, joints, blood vessels, and muscles in the foot are formed incorrectly. This results in either mild or severe deformities. Most notable is the `kidney shape' of the foot. It can affect one or both feet, more frequently the left. In about half of the cases, both feet are affected.
Clubfoot can occur by itself or it can be accompanied by other birth defects such as malformation syndromes or chromosomal syndromes.
There are three types of clubfoot:
Calcaneal Valgus
There is an angling of the foot at the heel. When this occurs, the top of the foot looks as if it is bent to the side and the toes point up and out.
Matatarusus Varus
In this the front of the foot is turned inwards.
Talipes Equinovarus
Here the foot is turned inwards and down.
In clubfoot, each child is likely to have some of each of the following:
Plantar flexion: this refers to the twisting of the ankle which causes the heel to be drawn up.
Cavus foot deformity: this refers to the high arch of the foot. In some cases a high arch is very noticeable. In other cases, because of the angling of the foot, the height may be difficult to determine. In these cases, a crosswise crease on the sole of the foot may be a good indication.
Varus: this refers to the inversion of the heel which causes the front of the foot to turn inward
Adduction of the forefoot: this refers to amount the forefoot is pulled downward
What is the cause?
There is no one known cause for clubfoot. It may happen in the womb due to cramping or twisting, somewhere around the 10th-12th weeks of pregnancy. Some believe that heredity or other factors known to cause birth defects may be to blame. These include use of drugs or alcohol, or experiencing certain diseases.
There are some diseases such as myelomeningocele and constriction band syndrome that may lead to clubfoot. Twice as many boys as girls have clubfoot and heredity may be a factor. If one child has it, there is a 3% to 4% chance a sibling may have it too. And, if one parent and one child have it, the odds increase to a 25% chance of a second child having it.
What are the symptoms?
Noticeable deformity in the foot
Stiffness in the ankle or in foot tendons
The calf appears shorter than the other leg (in cases where only one foot is affected)
Foot or feet turned or twisted awkwardly
Affected foot lacks the normal range of motion
What is the diagnosis?
The disorder is identified during a physical examination. A foot X-ray may be performed.
What is the treatment?
It is important to treat clubfoot as soon as it is diagnosed to avoid later problems. With proper and professional treatment, clubfoot does not represent a long-term disability or handicap. In many cases, it can be corrected within about six to eight weeks by exercise, manipulation and stretching of the heel cord, and casting. Chances of correction are optimal during the first two weeks of life, when the tissues and ligaments are very elastic-like and pliable. The treatment should begin as early as possible - ideally, just after birth when the foot is easiest to reshape.
In more severe cases of clubfoot, surgery may be required to lengthen the heel cord. The forefoot correction and hind foot correction take more time and the heel cord lengthening can be left until the child is older. Surgery can be accompanied by scarring, stiffness and muscle weakness that can become disabling in later years. If passive treatment of the condition, such as using stretching or casting or both, is used, it is important to have the foot evaluated periodically. There is a tendency for clubfoot to relapse because of growth. This is true particularly in the first two or three years of life, although it is possible it may happen even up to age 7. Splints are used after the last cast comes off to help prevent the clubfoot from reappearing. The splints must be worn full-time for several months, and then nightly for the following two to four years.
According to health experts, testing whether a person has swine flu (H1N1) is not easy and it can take days to confirm that suspected cases are actually caused by the virus.
The World Health Organisation has confirmed 79 cases spreading from Mexico - where it has reportedly killed up to 149 people - into the United States, Canada, New Zealand and Europe, raising fears of a pandemic. But officials suspect more than 1,600 people may have the infection - a disparity explained in part because there is no quick test, according to virologists at the University of Warwick in Britain.
While testing for seasonal flu is relatively simple, doing the same for H1N1 is far more complicated and none of the techniques are widely available. One way to confirm swine flu is with a test that involves growing a virus culture in a lab and then sequencing its genetic material. Testing for an increase in antibodies and another technique called real-time PCR (polymerase chain reaction) are the other diagnostic approaches.
The PCR technique amplifies copies of genes so researchers can easily compare a sample taken from a sick person to the genetic material of the potentially pandemic infection. With the sample may contain a small number of copies of the virus genes and the technique multiplies them in a test tube to give millions of copies of the virus genes, which are easy to detect.
The first step for doctors and health officials is often collecting a sample at a local clinic or hospital and sending it to a better-equipped lab for analysis. This can produce some of the biggest delays. Next researchers must purify the sample to get rid of natural compounds that may interfere with a reading - something that also takes time. Once you know the genetic makeup of the virus, it can be found whether the (genetic) sequence is that of the suspected infection.
If everything was optimised and there were plenty of people around to handle the result one could easily get a result the same day. The PCR can within a few hours compare the genetic makeup of the virus in the sample with that of the pandemic virus. But the biggest challenge for researchers is designing a rapid test that health officials can use in the field.
Drugs play a vital role in the prevention and treatment of most diseases. They should be taken only on prescription by a registered medical practitioner. By and large, all drugs are potent weapons with a double edge: judicious and appropriate use can give relief, reckless “self-prescription” can be dangerous. Therefore, medicines should only be taken as directed by the doctor. According to government rules, manufacturers and drug stores are obliged to give a product information leaflet with the purchase of every medicine. In practice, this not being done.
Therefore, most people are not aware of essential information on the drugs that they consume. In order to help such people we are developing a database on drugs being sold in India that provides important information that is the name of the medicine, the name(s) of various brands under which the medicine is being marketed, the use(s) of the medicine, side-effects which might occur, situations when the drug can be used but with utmost care, and situations when the drug must not be used. We have already listed nearly all single ingredient medicines. Now, we are in the process of adding multi-ingredient drug combinations that contain more than one medicine. We hope you will find this section useful.