CLUBFOOT TREATMENT

When Should Clubfoot Treatment Begin?

Most babies with clubfoot can be diagnosed before birth with a painless ultrasound. Studies show that 10% of clubfoot cases can be discovered as early as 13 weeks into pregnancy. At 24 weeks, about 80% of clubfoot cases can be found. There is approximately a 20% false positive rate.

Clubfoot treatment for babies should begin within 7-10 days after birth because the baby’s bones, ligaments and tendons are still soft and can be gently and slowly be moved into the normal position. If parents discover their baby has a clubfoot after birth, they should consult with a foot surgeon, like Dr. K, as soon as possible.

Dr. K has been specially trained in the Ponseti Method, which has shown more success in correcting clubfoot than major surgery. Dr. K is one of the few surgeons who trained under Dr. Ponseti, who passed away in 2009. The Ponseti Method is becoming the standard treatment in the U.S. and around the world.

The Ponseti Method is endorsed and supported by World Health Organization, National Institutes of Health, American Academy of Orthopedic Surgeons, Pediatric Orthopedic Society of North America, European Pediatric Orthopedic Society and many more.

The Ponseti method features a treatment phase and a maintenance phase.

During the treatment phase, the baby’s clubfoot (or feet) is gently moved towards the correct position and then placed in a tiny plaster cast. A new tiny plaster cast is placed on the baby’s clubfoot every 5 to 7 days. With each new casting, the baby’s clubfoot is gently moved about 10-15 degrees. The Ponseti Method allows the bones, ligaments and tendons inside the foot to gradually re-shape during casting.

Usually, five to six casts are required for clubfoot correction over a period of two months. However, very stiff feet may require 8 or 9 plaster casts. Before the final cast, 70% of babies will require a small surgical procedure to lengthen their Achilles tendon. This simple procedure will be done with a local painkiller and only takes about 10 minutes.

The last clubfoot cast is left on for two and a half to three weeks to help with healing. By the time this cast is removed, the tendon has usually healed to its proper length.

On the same day the last cast is taken off, and the foot is in the normal position, the baby will start the maintenance phase, which involves wearing a tiny brace on the foot so that the bones, tendons and ligaments will settle into their permanent position.

Parents should not wait a few days to start the brace, or the foot will go back to its clubfoot position. The brace must be worn about 23 hours per day for approximately three months. This is very effectively in 95% of patients. The brace will not cause developmental problems for the baby.

The foot brace consists of an adjustable length aluminum bar with adjustable footplates where tiny shoes attach. The baby may feel uncomfortable at first when trying to kick his or her legs separately, but will soon learn to kick both legs simultaneously and feel comfortable.

If you lay the brace on the floor with the shoes facing upward, your baby’s feet should fit snugly inside these special shoes. New shoes are needed when the baby’s toes completely curl over the edge of the shoe. The shoes are usually two sizes larger to allow for growth.

You may need to play with the brace settings to see what is most comfortable for your baby. Mark a line for the location of the toes the first time the shoes are worn, to indicate that the heel is down. If your baby was recently casted, it is normal for the foot to have some swelling, so the line may be different in just a few days. Later, the baby will be moved to a nighttime brace and will have more freedom during the day.

In rare cases where the foot returns to the clubfoot position after wearing braces, then surgery may be needed when the child is over two years of age. Clubfoot surgery should always be the last choice as it can cause scarring and is not a "cure" for clubfoot, although it may lead to some improvement.