What Is Clubfoot?

Congenital Clubfoot is one type of a lower leg deformity of unidentified causes that occurs in otherwise healthy infants. It is one of the most common congenital disorders.

Clubfoot causes the foot to turn inward and point downward. Shortened tendons and ligaments on the inside of the lower leg restrict outward movement and cause the foot to turn inward. Tight Achilles tendons cause the foot to point downward.

Clubfoot must be corrected in order for the child to walk properly. It is not difficult to correct. However, the method of treatment to use has been a subject of controversy for over 150 years. Although surgery became more popular than manipulation and serial casting during the1950's, there is now a growing demand for non-surgical techniques, particularly the Ponseti Method.

Clubfoot at birth, same child at 3 years after Ponseti treatment.

What Is The Ponseti Method?

It is a technique developed by Dr Ignacio Ponseti of the University of Iowa Hospital, USA, to straighten congenital clubfoot. It has been successfully used in America for over 45 years.

The treatment should begin in the first weeks of life to take advantage of the favourable elasticity of the tissues that form the ligaments, joint capsules and tendons in the foot. At each treatment, these structures are stretched with gentle manipulations. The treatment manipulates the bones and stretches the contracted tissues of the foot. A plaster cast is applied to hold the foot in place. The cast is left on for 5 - 7 days. This retains the corrected position and allows enough time for the muscles and ligaments to relax and the bones to grow into the corrected position. This way, the displaced bones are gradually brought into the correct alignment.

Dr Ponseti says:
"Parents of infants born with clubfeet may be reassured that their baby, if otherwise normal, when treated by expert hands will have normal looking feet with normal function for all practical purposes. The well-treated clubfoot is no handicap and is fully compatible with a normal, active life."

Clubfoot - Ponseti Management

How Many Times Does The Plaster Have To Be Reapplied?

Usually 4 to 6 but it may take more. Each child and each foot is individual.



Typical Ponseti casts (each cast is a different shape because it is correcting a different part of the foot)

How Can I Help?

Help your baby to relax during the procedure. You can take a feed, which you can give during the process of manipulation and plastering. A favourite toy is also useful to distract your baby. The Ponseti method, when done correctly, is a very gentle technique. Your baby won't be in pain during the treatment, but can get frustrated from being held still while the casting is taking place.

Will My Child Need An Operation?

In the majority of cases, yes. The procedure is called a Tenotomy. Some children do not require this, but 80-90% do.

Once your child's foot is in the correct position, the Achilles Tendon (above the heel) needs to be released. Your child's foot is put in the final, correct position. A plaster cast is applied to hold this position.

The Tenotomy is a simple procedure that takes about 10 minutes. It can be done under local or general anaesthetic. It is not at all invasive like the full, traditional clubfoot surgery that required 3-4 hours per foot. It's difficult to see where the cut was made after the casts are removed. It's 'pin prick' in size and doesn't even require stitches.

How Long Will My Child Be In Plaster?

The final plaster is removed after three weeks. Your child will then be given some specially made boots that are joined together by a metal bar, called a Foot Abduction Brace (FAB). The bar holds the feet in their correct position. The FAB must be worn all the time for 3 months. You can remove the splint for one hour a day in order to bath your baby.

After 3 months your child will only need to wear the FAB while asleep, including the daytime naps.

Your child must sleep with the FAB until they are 3 - 4 years old in order to prevent relapse. During the day your child can be barefoot or wear any good shoe, no special shoes are required. No physical therapy is required, the movement of the foot, and weight bearing as your child starts to stand and walk, is sufficient.

More information on clubfoot and the Ponseti Method:

www.uihealthcare.com/topics/medicaldepartments/orthopaedics/clubfeet/index.htm

www.clubfoot.co.za

www.steps-charity.org.uk