Nursing Care Plan (NCP) for Clubfoot

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Outline

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, it 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

Nursing Intervention (ADPIE) Rationale
Perform complete assessment, noting the severity of the defect  note: note inward vs outward. Severity of the foot. Color, calf size bilaterally.
Provide education to parents on condition  provide information from what the defect is, causes, and treatments. Helps alleviate any anxiety or worry they may have 
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.

Also assess for any skin breakdown (blisters/open sores) could could indicate an improper fit and need to be adjusted 

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 Massage

Heat / cold

Following treatment, the calf muscles will be smaller and may have pain and soreness with activity. Over time, this discomfort will lessen.

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.

Writing a Nursing Care Plan (NCP) for Clubfoot

A Nursing Care Plan (NCP) for Clubfoot starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

  • https://www.mayoclinic.org/diseases-conditions/clubfoot/symptoms-causes/syc-20350860
  • https://my.clevelandclinic.org/health/diseases/16889-clubfoot
  • https://orthoinfo.aaos.org/en/diseases–conditions/clubfoot/
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Transcript

Hi everyone. Today, we are going to be creating a nursing care plan for clubfoot. Let’s get started. We’re going to go over the pathophysiology of clubfoot. Clubfoot is a congenital deformity of shortened tendons causing the foot to twist inward while it’s not painful during infancy. If left untreated, it can cause permanent damage and an inability to walk. Some nursing considerations: you want to do a full assessment, range of motion exercises, monitor skin breakdown from the braces or the casting, non-pharmacological pain relief methods, and pre and post-surgical care. Desired outcome: the patient will have optimal function of the foot, or their feet will have adequate mobility. 

And here’s a picture for you guys to see what clubfoot looks like. You’re going to see here in the picture that the foot is turned inward. See how these are inward. And the top of the foot is kind of pushed downward this way. This would be what it looks like in an infant. 

So, we’re going to go ahead and go into the care plan. We’re going to be writing down some subjective data and some objective data. So, what are we going to see with these patients? So, the main thing you’re going to notice is the foot being twisted inward, and that inability to walk. Other things you’re going to see they’re going to complain of some soreness of the leg that’s usually post-treatment. And that top foot is twisted downward. 

So, in the interventions, we want to do a complete assessment. So, we’re going to assess, making sure that we’re going to be noting the severity of the defect. We’re going to see inward versus outward. We want to make sure we’re checking the color, maybe the size, the calf size bilaterally, another intervention that we’re going to do, we’re going to do some range of motion. So, whether that is active range of motion or passive range of motion, we’re going to do both of those and try to get the flexibility and prevent any sort of contracture forming. Another invention that we’re going to be doing is applying caste and or brace. This type of treatment, which is known as Ponseti Method helps realign the joints and it stretches those tendons gradually over time, ensuring perfusion. You want to make sure that there’s perfusion intact at the distal part of that cast and the brace. You also want to assess for any sort of skin breakdown, such as blisters or open sores that could indicate that there’s an improper fit of that cast or brace that may need to be adjusted. Another intervention is any sort of non-pharmaceutical pain are ways of relieving pain, and that’s usually massaging or heat or cold therapy, especially after doing any of those range of motion exercises. Those muscles will be sore with that activity. Another intervention we want to do is that we want to make sure that if any of those treatments we’ve tried with the patient has failed, surgery may be needed. So, we’re going to get the patient ready for surgery. We want to make sure we’re maintaining them on NPO status. We want to initiate starting an IV for IV access for fluids or medications that may be needed such as for nausea, sedation, and pain. We want to make sure we’re monitoring vital signs pre and post-surgery. And we want to make sure that we’re doing those dressing changes post-surgery – you’ll do that per protocol as needed. 

Okay, now we have that complete care plan. We’re going to go over some of the key points here. So, pathophysiology, congenital deformity of the shortened tendons that causes the foot to twist inwards. The exact cause is unknown, but it appears to be a genetic disorder. Some risk factors are smoking during pregnancy, maternal recreational drug use, and any maternal infections. Some subjective and objective data that you will see with these patients. They’ll have soreness of the leg. The top of the foot that’s twisted downward, will be twisted inward, which is very, very classic. The inability to walk properly. You want to provide those range of motion exercises. So that’s going to be your active range of motion and that passive range of motion. You want to apply the braces and the casting and assessing for any sort of skin breakdown, pain, and surgery. You want to make sure you’re providing any sort of nonpharmacological methods of pain relief, such as heat or cold compress and massages. You want to prepare and educate the family on surgery if all the other treatments fail. Awesome job.

We love you guys. Go out, be your best self today, and as always happy nursing.

 

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