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.
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.
Patient will have optimal function of foot/feet; patient will have adequate mobility.
Clubfoot Nursing Care Plan
- Soreness of leg (post-treatment)
- Top of the foot is twisted downward
- Foot twisted inward
- Inability to walk properly
Nursing Interventions and Rationales
- Perform complete physical assessment, noting severity of defect
Determine baseline for treatment.
- Provide information for parents regarding the condition
Helps alleviate worry and anxiety. Help parents deal with concerns about patient’s condition.
- Apply casting or braces as required for non-surgical treatment
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.
- Provide range of motion exercises routinely per protocol and treatment orders
Improve range of motion, flexibility, and prevent contractures.
- Provide non-pharmacological methods of pain relief for older children experiencing leg pain
Following treatment, the calf muscles will be smaller and may have pain and soreness with activity. Over time, this discomfort will lessen.
- Assess skin for breakdown when using splints, braces and casts
Skin may break down with use of braces. Monitor for signs of blisters or open sores which may indicate an improper fit.
- 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
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.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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