Clubfoot is a birth defect that makes one or both of a baby's feet point down and turn in. Surgery used to be the main treatment for clubfoot, but orthopedic surgeons doctors who focus on conditions of the bones, muscles, and joints now prefer the Ponseti method. This is done in two phases:. Casting usually starts when a baby is a week or two old.
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Clubfoot is a deformity in which an infant's foot is turned inward, often so severely that the bottom of the foot faces sideways or even upward. Approximately one infant in every 1, live births will have clubfoot, making it one of the more common congenital present at birth foot deformities.
Clubfoot is not painful during infancy. However, if your child's clubfoot is not treated, the foot will remain deformed, and he or she will not be able to walk normally. With proper treatment, however, the majority of children are able to enjoy a wide range of physical activities with little trace of the deformity.
Most cases of clubfoot are successfully treated with nonsurgical methods that may include a combination of stretching, casting, and bracing.
Treatment usually begins shortly after birth. In clubfoot, the tendons that connect the leg muscles to the foot bones are short and tight, causing the foot to twist inward. Although clubfoot is diagnosed at birth, many cases are first detected during a prenatal ultrasound. In about half of the children with clubfoot, both feet are affected. Boys are twice more likely than girls to have the deformity. Clubfoot can range from mild to severe, but typically has the same general appearance.
The foot is turned inward and there is often a deep crease on the bottom of the foot. Left A child with clubfoot in both feet called bilateral. Right Note the deep crease on the bottom of the foot in this child with a unilateral clubfoot. In limbs affected by clubfoot, the foot and leg are slightly shorter than normal, and the calf is thinner due to underdeveloped muscles.
These differences are more obvious in children with clubfoot on only one side. Regardless of the type or severity, clubfoot will not improve without treatment. A child with an untreated clubfoot will walk on the outer edge of the foot instead of the sole, develop painful calluses, be unable to wear shoes, and have lifelong painful feet that often severely limit activity. Parents of infants born with clubfeet and no other significant medical problems should be reassured that with proper treatment their child will have feet that permit a normal, active life.
Researchers are still uncertain about the cause of clubfoot. The most widely accepted theory is that clubfoot is caused by a combination of genetic and environmental factors. What is known, however, is that there is an increased risk in families with a history of clubfeet. The goal of treatment is to obtain a functional, pain-free foot that enables standing and walking with the sole of the foot flat on the ground.
Ponseti method. The most widely used technique in North America and throughout the world is the Ponseti method, which uses gentle stretching and casting to gradually correct the deformity. In the Ponseti method, long-leg casts are applied after the feet are correctly positioned. Treatment should ideally begin shortly after birth, but older babies have also been treated successfully with the Ponseti method. Elements of the method include:. A patient after correction of a left-sided clubfoot deformity with the Ponseti cast method.
Note that the calf is slightly smaller on the left side compared to the normal right leg. French method. Another nonsurgical method to correct clubfoot incorporates stretching, mobilization, and taping. The French method — also called the functional or physical therapy method — is typically directed by a physical therapist who has specialized training and experience. Like the Ponseti method, the French method is begun soon after birth and requires family involvement.
Each day, the baby's foot must be stretched and manipulated, then taped to maintain the range of motion gained by the manipulation. After taping, a plastic splint is put on over the tape to maintain the improved range of motion. This method requires approximately three visits to the physical therapist each week. Because this is a daily regimen, the therapist will teach the parents how to do it correctly at home.
After 3 months, most babies have significant improvement in foot position, and visits to the physical therapist are required less often. Like children treated with the Ponseti method, babies treated with the French method commonly require an Achilles tenotomy to improve dorsiflexion of the ankle. To prevent recurrence of the clubfoot, the daily regimen of stretching, taping, and splinting must be continued by the family until the child is 2 to 3 years old.
Although many cases of clubfoot are successfully corrected with nonsurgical methods, sometimes the deformity cannot be fully corrected or it returns, often because parents have difficulty following the treatment program.
In addition, some infants have very severe deformities that do not respond to stretching. When this happens, surgery may be needed to adjust the tendons, ligaments, and joints in the foot and ankle. Because surgery typically results in a stiffer foot, particularly as a child grows, every effort is made to correct the deformity as much as possible through nonsurgical methods.
Even an infant with severe deformities or clubfeet associated with neuromuscular conditions can improve without surgery. If a child's foot has been partially corrected with stretching and casting, then the surgery required to fully correct the clubfoot will be less extensive. Your baby's clubfoot will not get better on its own. With treatment, your child should have a nearly normal foot, and he or she can run and play and wear normal shoes.
The calf muscles in your child's clubfoot leg will also stay smaller, so your child may complain of "sore legs" or getting tired sooner than peers.
The affected leg may also be slightly shorter than the unaffected leg, but this is rarely a significant problem. This is the key to getting over the irritability quickly. If your child is using the solid bar, he or she can kick and swing the legs simultaneously with the brace on. You can help facilitate this by gently bending and straightening the knees by pushing and pulling on the bar of the brace.
If your child is using the dynamic bar, it is also helpful to gently move the legs up and down as your child adjusts to the brace. Children do better if you develop a fixed routine for the bracewear. During the years of night and naptime wear, put the brace on anytime your child goes to the "sleeping spot.
Your child is less likely to fuss if this is a consistent routine. A bicycle handle bar pad works well for this. By padding the bar, you will protect your child, yourself and your furniture from the metal bar. Lotion will make the problem worse. Some redness is normal with use. Bright red spots or blisters, especially on the back of the heel, usually indicate that the heel is slipping. It is important to check your child's feet several times a day after starting bracing to make sure no blisters are developing.
If your child continues to escape from the brace, try the tips below. After each step, check to see if the heel is down. If not, proceed to the next step. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein.
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. An infant with clubfoot. Appearance Clubfoot can range from mild to severe, but typically has the same general appearance.
Clubfoot that is not treated causes serious disability as a child grows. To Top. Nonsurgical Treatment The initial treatment of clubfoot is nonsurgical, regardless of how severe the deformity is. In Achilles tenotomy, the doctor uses a very small instrument to cut the heel cord.
Orthopaedic Knowledge Online Journal Accessed August Examples of a solid bar brace. Left The Markell Abduction Brace. Right The Mitchell Abduction Brace. Left Courtesy of Markell Shoe Company. Right Courtesy of MD Orthopaedics.
The Dobbs Dynamic Abduction Brace. Courtesy of Orthotic and Prosthetic Lab, Inc. Bowed Legs Blount's Disease. Vitamin D for Good Bone Health. What Is a Pediatric Orthopaedic Surgeon? Play with Your Child in the Brace This is the key to getting over the irritability quickly. Make It a Routine Children do better if you develop a fixed routine for the bracewear. Pad the Bar A bicycle handle bar pad works well for this. Never Use Lotion on the Skin Lotion will make the problem worse.
Prevent Escapes If your child continues to escape from the brace, try the tips below. In boots or sandals with a single strap, tighten it by one more hole, using your thumb to hold the foot and tongue in place. In boots with multiple straps, tighten the middle one first, using your thumb to hold the foot and tongue in place. Try double socks. In boots with a removable insert, place one sock directly over the foot, and a second sock over the insert to help take up excess room.
Remove the tongue of the shoe — this will not harm your child.
Using the Ponseti technique to correct talipes (clubfoot)
If you're coming to GOSH, please remember that hospital visitors are limited to one carer per family. This must be the same carer each day. Unfortunately, siblings will not be able to visit the hospital. In line with the latest national advice, we are now testing all inpatients for COVID, as well as offering testing to the parent or carer who accompanies them. While we understand that these measures will be difficult for families, our priority is the safety of all GOSH patients, families and staff. This page explains about using the Ponseti technique to correct talipes clubfoot and what to expect when your child comes to Great Ormond Street Hospital GOSH to have this procedure.
The Ponseti Method: Casting Phase
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