Chapter 2425: Similarities and Differences
Let’s talk about the inward-turning of a child’s foot, which is very common in pediatric orthopedics, commonly known as clubfoot. It is not greatly related to the bones, but rather to anomalies in tendon and ligament development.
How does clubfoot occur? Some children can be diagnosed with clubfoot through mid-to-late pregnancy ultrasound while still in their mother’s belly, indicating that it’s likely not a fetal deformity, because clubfoot is almost never seen in early pregnancy ultrasounds.
Generally, medically speaking, clubfoot appears during a mother’s pregnancy period when the child changes from a normal foot to clubfoot. It may be due to improper fetal positioning or a large fetus, causing the child’s feet to become deformed due to compression in the mother’s uterus. Since medicine cannot fully determine a single cause, other causes cannot be excluded, and doctors are continuously researching whether genetic and other factors lead to abnormalities in foot development during the child’s growth.
Like other conditions, clubfoot may just be a simple congenital foot deformity or it may be a sign appearing secondary to other diseases. Secondary to other diseases, the most common are neurosurgical conditions, including central nervous system diseases and peripheral nervous system diseases. Central nervous system diseases involve problems with the brain and spinal cord, which are serious matters requiring careful and thorough examination and differentiation by doctors.
Pediatric neurosurgical examinations are mostly similar to those for adults, checking the patient’s state of consciousness, and testing various superficial and deep reflexes. The only distinction with children is that infants are in the process of growth and development, unlike adults who have fully developed. This leads to the fact that a child is not born with a fully grown head. After birth, a child’s brain continues to develop, and the head gradually enlarges as the body develops, exhibited by the head circumference having a relatively normal range of physiological enlargement.
Measuring head circumference in infants is a routine item in normal healthcare check-ups. Additional checks in emergencies are primarily to prevent sudden diseases in children, as well as the oversight by some parents who fail to bring their child for timely check-ups.
By measuring head circumference, we can understand that the child’s brain is developing and must expand outward during the development process. The physiological structure of humans is designed to accommodate this aspect of growth by intentionally not closing all cranial sutures immediately after birth, but waiting until the child’s brain has developed fully to fuse the cranial bones together, forming the most solid helmet to protect the brain. For this reason, before the cranial bones fuse, an infant’s skull is much more fragile than that of an adult. Any head injury in an infant can be very severe, much more so than in adults.
Before several cranial bones have completely fused, the gap area between them resembles an open door, which is called the fontanelle. There are two such fontanelles: one at the front center of the child’s head, diamond-shaped, known as the anterior fontanelle, which fully closes at around one to one-and-a-half years old. The posterior fontanelle is triangular at the back of the head, and some children have it closed at birth, while at the latest it closes by six to eight weeks.
Sometimes clinically, we can see newborns with pointed heads that seem deformed, mostly due to the anterior fontanelle not being closed, which is nothing to worry about because it will naturally look better as it closes over time. Experienced elders claim that it’s the pointed head of the baby being squeezed out during childbirth, which is not an entirely baseless explanation. Since the baby’s unfused fontanelle allows for adjustment to conform to changes in the mother’s birth canal, it facilitates a smooth delivery for the mother.