FOOT ORTHOSES
Club Foot
What is clubfoot?
Clubfoot is the most common deformity of the foot bones and joints in newborns. It occurs in about 1 in 1000 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 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 lead a normal, active life.
Starting Treatment
The foot is gently manipulated for about 1 minute every week to stretch the short and tight ligamments 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 favourable 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.
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How does Ponseti management correct the deformity?
Keep in mind, the basic clubfoot deformity. Compare the normal relationship 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 to this deformity, is achieved by reversing this rotation, gradually by serial casts, over a period of weeks.
When should treatment by Ponseti management be undertaken?
When possible, start soon after birth (7 – 10 days)
How late can treatment be started and still be helpful?
Most clubfoot deformities can be corrected throughout childhood using this technique.
When treatment is started early, how many cast changes are usually required?
Most clubfoot deformitiesw can be corrected in approximately six weeks by weekly manipulations followed by plaster cast applications. If the deformity is not corrected over six or seven plaster cast changes, the treatment is most likely faulty.
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