Clubfoot (Talipes Equinovarus) is the most common deformity of the bones and joints in the feet of newborns, affecting 1 in 1,000 babies. Clubfeet are of unknown origin and occur in otherwise healthy infants. Treatment is successful as long as it is started early. The well-treated clubfoot is not a handicap and is fully compatible with an unhindered, active life.
The majority of clubfeet can be corrected in six to eight weeks with a treatment called the Ponseti technique, which involves gentle manipulations and application of plaster casts. Treatment should begin within the first week or two of life to take advantage of the elasticity of the tissues. The foot will be gently manipulated to stretch the ligaments and tendons on the inside, back and bottom of the foot and a plaster cast will be applied. The cast will hold the correction in place and help to relax the tissues for the next manipulation. A new cast will be applied every week. In most cases, the Achilles tendon will need to be completely divided in order to complete the correction; this is a small surgery. The tendon will regenerate to the proper length to allow complete correction of the foot by the time the last cast is removed. Most often four cast applications are done before the surgery. The cast placed at the time of the Achilles tendon lengthening is removed after two weeks.
Clubfoot deformity tends to relapse after correction. In order to prevent relapse, your child will be prescribed a Ponseti brace. This brace consists of shoes with soft straps and a bar that connects them to keep the feet pointing outward. The brace must be worn full time until your child is 9 months old.
After that, your child will need to wear the shoes only at night until he/she is three years old. It is very important that the brace not be removed, otherwise recurrence of the clubfoot deformity will almost always occur. Use of the brace will not delay the child’s development with regard to sitting, crawling or walking. The goal of treatment is to reduce or eliminate all of the components of the deformity so the child will have a functional, mobile, pain-free foot.
Helpful Tips for Wearing the Brace
- Expect your child to fuss for the first couple of days when in the brace. This is not because the brace is hurting him/her, but because it is something new and different.
- Play with your child in the brace to help him/her get used to not being able to move his/her legs independently.
- Gently push/pull on the bar of the brace to teach your child to flex and extend his/her knees.
- If you notice any red spots or blisters on your child’s feet, call the orthotist to see if modification is necessary.
- If the clubfoot deformity is not corrected your child will develop an abnormal gait. The limp is severe. Because the child will walk on the outside and top of the foot the skin will break down. This can leave your child susceptible to infections. Also, walking on the outside of the foot can lead to joint problems. A link below shows a video of a grownup whose clubfeet were not treated.
- Manipulation in the cast is gentle and does not cause any pain
- Sometimes babies pull a Houdini on us and wiggle out of their casts. One of the reasons we place the cast above their knee is to prevent this. If your child does slip out of her cast, please call us right away for a new one. If she is out of her cast for a day or two, the treatment will probably take one or two more weeks.
The photographs in this pamphlet are of our patients. We are very thankful to their parents for permitting us to use their photographs in this educational pamphlet.
For more information call POBAR (Pediatrics of Brandon and Riverview) 813-720-8001
602 Vonderburg Drive
Brandon, Fl 33511
What is it like to walk without treatment for Clubfeet?:
Ponseti Method for Serial Casting:
What to bring to your appointment:
- Please download and bring a copy of the Pediatric Orthopedics of Brandon and Riverview new patient form, fill it out, and bring it with you to your child’s visit.
- Photo ID, insurance information and cards. Please provide any authorization or prescription referrals your insurance company may require.
- Copay for the visit.
- Phone and fax numbers for your child’s primary care physician and pharmacy.
- Copies of x-rays related to the visit.
- A parent or legal guardian must be present for the first consultation. If you are a legal guardian, please bring proof of guardianship. An adult other than a parent or legal guardian can bring the child to subsequent visits, but must have a signed note from a parent stating this is okay.
- We encourage you to bring toys, books, and snacks to keep your child content while waiting.
- Please arrive 30 minutes early for a first time appointment.