Club Foot Treatment

Information For Parents

What is clubfoot?

Clubfoot is the most common deformity of the foot bones and joints in newborns. It occurs in about 1 in 1,000 babies. The cause of clubfoot is not exactly known, but it is most likely a genetic disorder and not caused by anything the parents did or did not do. Therefore, there is no reason for parents to feel guilty about having a child with clubfoot. The chances of having a second child with a clubfoot are approximately 1 in 30.

Parents of an otherwise normal infant who is born with clubfoot can be reassured that their baby, when treated by an expert in this field, will have a normal-looking foot with essentially normal function. The well-treated clubfoot causes no handicap and the individual is fully able to live a normal active life.

Starting treatment

The foot is gently manipulated for about 1 minute every week to stretch the short and tight ligaments and tendons on the inside, back, and bottom of the foot. A cast that extends from the toes to the groin is then applied. The cast maintains the correction< obtained by the manipulation and relaxes the tissues for the next manipulation. In this manner, the displaced bones and joints are gradually brought into correct alignment. Treatment should begin during the first week or two of life to take advantage of the favorable elasticity of the tissues at that age.

Current Ponseti Management

Is Ponseti management now accepted as optimal treatment worldwide?

Over the past decade Ponseti management has become accepted throughout the world as the most effective and least expensive treatment of clubfoot.

How does Ponseti management correct the deformity?

Keep in mind the basic clubfoot deformity. Compare the normal relationships of the tarsal bones with that of the clubfoot . Note that the alus is deformed and the navicular is medially displaced. The foot is rotated around the head of the talus . Ponseti correction is achieved by reversing this rotation. Correction is achieved gradually by serial casts. The Ponseti technique corrects the deformity by gradually rotating the foot around the head of the talus over a period of weeks during cast correction.

When should treatment with Ponseti management be undertaken?

When possible, start soon after birth (7 to 10 days). However, most clubfoot deformities can be corrected throughout childhood using this management.

When treatment is started early, how many cast changes are usually required?

Most clubfoot deformities can be corrected in approximately 6 weeks by weekly manipulations followed by plaster cast applications. If the deformity is not corrected after six or seven plaster cast changes, the treatment is most likely faulty.

How late can treatment be started and still be helpful?

The goal is to start treatment in the first few weeks after birth. However, correction can be achieved in many cases until late childhood.

Is Ponseti management useful if treatment is delayed?

Management that is delayed until early childhood may be started with Ponseti casts. In some cases, operative correction will be required, but the magnitude of the procedure may be less than would have been necessary without Ponseti management.

Ponseti Cast Correction

Setup

The setup for casting includes calming the child with a bottle or breast feeding. When possible have a trained assistant. Sometimes is necessary for the parent to assist. The treatment setup is important. The assistant holds the foot while the manipulator performs the correction.

Manipulation and casting

Start as soon after birth as possible. Make the infant and family comfortable. Allow the infant to feed during the manipulation and casting processes.

Exactly locate the head of the talus

This step is essential . First, palpate the malleoli with the thumb and index finger of hand A while the toes and metatarsals are held with hand B. Next , slide your thumb and index finger of hand A forward to palpate the head of the talus in front of the ankle. Because the navicular is medially displaced and its tuberosity is almost in contact with the medial malleolus, you can feel the prominent lateral part of the talar head barely covered by the skin in front of the lateral malleolus.
The anterior part of the calcaneus will be felt beneath the talar head.
While moving the forefoot laterally in supination, you will be able to feel the navicular move ever so slightly in front of the head of the talus as the calcaneus moves laterally under the talar head.

Manipulation

The manipulation consists of abduction of the foot beneath the stabilized talar head. Locate the head of the talus. All components of clubfoot deformity, except for the ankle equinus, are corrected simultaneously. To gain this correction, you must locate the head of the talus, which is the fulcrum for correction.

Reduce the cavus

The first element of management is correction of the cavus deformity by positioning the forefoot in proper alignment with the hindfoot. The cavus, which is the high medial arch [1 yellow arc] is due to the pronation of the forefoot in relation to the hindfoot. The cavus is always supple in newborns and requires only elevating the first ray of the forefoot to achieve a normal longitudinal arch of the foot [2 and 3].

The forefoot is supinated to the extent that visual inspection of the plantar surface of the foot reveals a normal appearing arch–neither too high nor too flat. Alignment of the forefoot with the hindfoot to produce a normal arch is necessary for effective abduction of the foot to correct the adductus and varus.

Steps in cast application

Dr. Ponseti recommends the use of plaster material because it is less expensive and more precisely molded than fiberglass.

Preliminary manipulation: Before each cast is applied, the foot is manipulated. The heel is not touched to allow the calcaneus to abduct with the foot [4].