Nursing Care Plan for Clubfoot

Pathophysiology

Clubfoot is a congenital deformity of shortened tendons causing the foot to twist inward. While it is not painful during infancy, if left untreated, clubfoot can cause permanent damage and an inability to walk. In cases of isolated (idiopathic) clubfoot, the patient can begin therapy that includes casting, stretches and braces shortly after birth and may not require surgery.  In non-isolated clubfoot, the condition exists with other congenital abnormalities such as arthrogryposis and spina bifida.

Etiology

Although the exact cause is unknown, it appears that clubfoot is a genetic disorder that tends to run in families. Other risk factors may include maternal recreational drug use, maternal infections, smoking during pregnancy and having too little amniotic fluid.

Desired Outcome

Patient will have optimal function of foot/feet; patient will have adequate mobility.

Clubfoot Nursing Care Plan

Subjective Data:

  • Soreness of leg (post-treatment)

Objective Data:

  • Top of the foot is twisted downward
  • Foot twisted inward
  • Inability to walk properly

Nursing Interventions and Rationales

  1. Perform complete physical assessment, noting severity of defect

  2. Determine baseline for treatment.

  3. Provide information for parents regarding the condition

  4. Helps alleviate worry and anxiety. Help parents deal with concerns about patient’s condition.

  5. Apply casting or braces as required for non-surgical treatment

  6. This type of treatment (Ponseti method) helps realign the joints and stretch the tendons gradually over time. Ensure perfusion is intact distal to the cast/brace.

  7. Provide range of motion exercises routinely per protocol and treatment orders

  8. Improve range of motion, flexibility, and prevent contractures.

  9. Provide non-pharmacological methods of pain relief for older children experiencing leg pain

    • Massage
    • Heat / cold
  10. Following treatment, the calf muscles will be smaller and may have pain and soreness with activity. Over time, this discomfort will lessen.

  11. Assess skin for breakdown when using splints, braces and casts

  12. Skin may break down with use of braces. Monitor for signs of blisters or open sores which may indicate an improper fit.

  13. Provide pre- and post-operative care.

    • Maintain NPO status prior to surgery
    • Initiate and maintain IV access
    • Administer IV fluids and medications for nausea, sedation and pain appropriately
    • Monitor vitals pre- and  post-op
    • Perform dressing changes and wraps per protocol and as needed
  14. In cases of severe deformity and when other treatments have failed, corrective surgery may be the best option.

    Ensure surgical sites remain clean, dry, and free from infection.

    Monitor for signs of post-op complications such as pneumonia, bleeding, and blood clots.


References

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