Dropping the PA with every trim to match the opposite foot invariably increases tension on all structures and will slowly remodel the face of PIII, the L zone, sole depth and articular surface. However, even with lower grade clubs this practice can create a remarkable air gap along the ground surface of the foot from heel to toe. Growth rings will be quite uniform or slightly wider at the heel, especially the lateral heel. Note wider growth rings at the heel than the toe and the pastern/toe relationship, The 10° PA is evidence of excessive toe loading, In the radiograph, note debris that has invaded the toe. Growth rings become remarkably wider at the heel than the toe, clearly demonstrating the imbalance of forces between the DDFT and its opposing antagonist component, the laminae. The shoe needs slight toe extension to assure the largest tendon gap and heel extension to prevent luxation of the coffin bone and toe lift for the first 30 to 45 days following surgery.
Figure 12: At first glance this foot might appear to have rotation, but note the parallel arrangement between horn wall and proximal face of coffin bone. Right: Frayed heel tubules are one of the first signs of heel crush. Before trimming, most all grade 2 club feet will have a 5 to 8° PA and can be as high as 10 to 12°. Even if the heel is removed and the PA is subsequently lowered, it will drift back up over 4-6 weeks. Bone angle can be considerably greater on grade 3 clubs; it is not unusual to find a 60° BA on these feet. Bone angle. Bone angle, which can be measured from low beam lateral radiographs, should be taken into consideration. Note bone angle shape and digital alignment. To better understand the potent effects of the DDFT tension, we need only to greatly reduce the forces at play and observe the medical benefits seen as accelerated sole growth, return of healthy papillae (as seen on the venogram), reduced heel growth and increased toe growth. A grade 2 club foot is the most common grade and most often missed, as it can appear to be a healthy foot compared to the opposite grade 2 low heel (slam dunk) foot.
Redden defined 4 basic categories of club feet based on increasing severity of hoof capsule distortion from grade 1 at the lowest to grade 4 at the highest.1 Radiographic evidence can also be correlated to the various categories. The pastern is displaced dorsally, creating a linear plane along the pastern and face of the hoof capsule. This DDFT tension laxity closely resembles the relationship of the pastern to the hoof capsule that occurs following a DDFT tenotomy, a procedure that allows the pastern bones to sag, shifting load to the posterior aspect of the coffin joint/navicular area and associated components of the heel. The face of the pastern is pushed dorsally in a straight plane with the face of the hoof and the heel bulb will have a fuller appearance, though this is difficult to detect at a very young age as the foot is smaller than the pastern. However, the heel grows back in 10-15 days. However, positive results require a few weeks as the foot begins to overcome the ill effects of imbalanced DDFT tension. Conservative clubfoot regimens require a minimum commitment of four years and are substantially impacted by poor compliance. You will need to follow the bracing program strictly until your child is 4 years old.
Well 27 years later, here I am, mother of four, wife to one and an avid Softball player. The foal with a grade 3 club foot is normally born with DDFT contraction syndrome, with one foot contracted more than the other. One component does not fail alone but affects adjoining support structures. There have been many outstanding 6-11 players and even some players who were listed in high school at 7 feet but later found to be an inch shorter once they were measured in college or the NBA. Since the exact cause of club foot is not understood, there is no specific prevention. There are numerous structures in the foot that give us precision, control, and a vast range of movement. It can affect any joint in the body including the neck. Radiopaque paste along the face of the foot describes the wall proper, which is not visible on any radiographs without an opaque marker.