‘Covid-19 and the foot (1)’

Welcome to ‘a discussion about Covid-19 and the impact of early management of club foot’.

As a foot health journalist my eye tends picks up anything feet. And Friday’s  Daily Telegraph letters carried correspondence about an unlikely effect of Covid-19 upon the management of club foot. Of course we already know about the effect of diverting attention away from cancer, much published in the news and how clinical staff, with decimated clinics, are imploring patients to make new appointments. The scare is the risk of recoccurence of cancer that has lain dormant and not being managed expediently.

Let’s look at a condition that for most doctors, let alone foot surgeons, is not a daily occurrence and so it is at specialist centres that this condition is managed –

THE CLUB FOOT

Two specialties 
One children (paediatrics) the other neonatal (orthopaedic) surgery.


What is club foot?

The deformity is so called because the shape of the foot turns like a ‘golf club’. These names stick but it has the name congenital talipes equinox-varus or CTEV. Anyone with orthopaedic training will know about this condition but few really see it. Sam Dellenbaugh MD edits a article on one of my favourite websites Footeducation.com.

I studied in 1975-78 when the incidence was given as 1 in 1000 births. This US based article (click on Footeducation.co,) still uses the same incidence which sounds benign if expressed as only 0.1%.

A recent letter reported in the Daily Telegraph…

David Jones and Chris Lavy, the former, an orthopaedic surgeon (Great Ormond Street), the latter a Professor of orthopaedics with the title of Chairman of Global Clubfoot Initiative (University of Oxford), showed concern that during the pandemic. Early intervention using minimal surgery during those critical first weeks of neonatal life could avert damage and detract from the full potential that treatment can offer. They say;

“The treatment of babies with clubfoot has become difficult or impossible in Britain during the pandemic.”

That there will be a backlog of cases would arise is inevitable…


So why does treating club foot matter?

Correction of this congenital (born with) condition is more difficult to manage in adulthood as contractures occur and any deformity becomes rigid. The heel cord tendon (achilles) fairs badly and leads to walking problems as it becomes tight and thin. The development of arthritis in the mid or hind foot arises without early treatment. The resistant shape with joint stiffness means skin is battered and can form thick calluses, ulcerations and blistering. Footwear selection is a nightmare for patients. The chances of us seeing the adult cases as we used to when I was a teenager in the seventies seems unlikely but Jones and Lavy are not wrong to remind us and the population that we don’t want to see untreated club foot as much as we don’t want to see the re-emergence of smallpox. Amidst Covid-19 and its own horrors, perhaps it is easy to take one’s eye off the ball for a moment. Removing the clinical realities for a moment, let’s go to Hollywood…

Anyone who has watched Kevin Spacey in ‘The Usual Suspects‘ as Roger Klint knows how he used his club foot to look weak. Spoiler Alert!!! The end of the film shows him changing from his awkward walking pattern to a normal style of walking.  As someone trained to study human movement, for me this had an enormous impact both from the point of view of a skilled actor using a deformity to create an character image and the effect on walking and human deportment. Select the last 2 minutes only BUT DO NOTE there is swearing at one point.

Last 3 minutes of the film The Usual Suspects. Note there is swearing in this sequence. Fast forward to  3.40 secs and onwards to avoid the preamble

Life is tough enough coping with a normal body but if we can do something about it early, and avoid customised shoes having to be used, it just helps that little.

Link to Global Clubfoot and its initiative for those who want more information click here


 

Thanks for reading ‘Covid-19 and the Club foot’ this article written by David Tollafield


Published by Busypencilcase Communications Ltd Est. 2015