Clubfoot

What is clubfoot?
Clubfoot is a congenital deformity of the foot. It results from the abnormal development of the muscles, tendons, and bones in the foot while the fetus is forming during pregnancy. The incidence rate for children born with clubfoot is 1 in 1000. This is the most common birth defect to need intensive orthopedic treatment.

 

 

What is the difference between Postural Clubfoot and Congenital Clubfoot?
Postural Clubfoot: In rare cases, clubfoot is just the result of the position of the baby while it is developing in the mother’s womb (postural clubfoot). With light manipulation and casting this is easily corrected.
Congenital Clubfoot: This is a true birth defect, and is more common than postural clubfoot. Although clubfoot is recognizable at birth, the severity of the deformity can vary from mild to an extremely rigid foot that is resistant to manipulation. The collagen of the lower leg and foot are abnormal and this makes congenital clubfoot more difficult to treat.

How is clubfoot corrected?
Clubfoot in an otherwise normal child can be corrected using the Ponseti Method of manipulation and plaster cast applications. Ponseti Method Treatment should begin in the first week or two of life in order to take advantage of the elasticity of the tissues that form the ligaments and tendons in the foot. A small surgical incision is almost always required at the back of the heel. After cast treatment,patients are placed in special orthopedic shoes held together with a “Dobb’s Bar”.

 

How long will the child need to wear the Dobb’s Bar and shoes?
When the last cast is removed the shoes and bar are applied. The child wears them day and night until instructed by their physician, approximately 9-11 months of age. Then they switch to night time only wear of the same shoes and bar until they are 3 years old.

What if my child doesn’t like or kicks off his/her shoes?
Parents have a very important role once the child is put in shoes with the bar. After the first day or two, infants become accustomed to the shoes and play as normal. Parents may also teach the child to move his or her legs at the same time, making it easier for the child to learn to move about. If parents are not vigilant and strict about keeping the shoes on, the feet might relapse. If parents have continued difficulty keeping the shoes on, they must visit the orthotist for modification.

What is the future like for a child who has clubfoot?
Babies treated using the Ponseti Method will have normal looking feet, with good mobility and function throughout life. The long term outcomes from this method have far exceeded those of surgical treatments. Follow-up studies of clubfoot patients show that children and adults with corrected clubfoot may participate in athletics like anyone else.

“6 month old POBAR patient undergoing successful clubfoot treatment”

Clubfoot Treatment

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.

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Treatment

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
three weeks.

 

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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 3 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.

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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.

Frequent Questions

  • What happens if the clubfoot deformity is not corrected?
    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.
  • Does the manipulation hurt?
    Manipulation in the cast is gentle and does not cause any pain.
  • Why is the cast placed above the knee?
    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.

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