The Clubfoot occurs when the foot and ankle are twisted permanently. In clubfoot, the ligament and tendons which holds the muscles to bones very tight. It is a congenital deformity.
Clubfoot is classified in two groups:
- Isolated clubfoot: It is very common form of deformity and occur to children who have no medical issues.
- Non-isolated clubfoot: It occurs in combination with various health condition.
The cause of clubfoot is not clear, it may be the combination of genes and environment.
- Affected leg may be shorter.
- Calf muscles in affected leg is under developed.
- Top of foot is twisted downward and inward.
An orthopedic surgeon is recommended for the surgical treatment to correct bone structure of foot. There are non-surgical and surgical treatment for clubfoot.
Ponseti Method: It is a widely used technique throughout the world. In this method a gentle stretching and casting is done to correct the deformity.
The elements of ponseti method includes:
- Manipulation and casting- The baby’s foot is stretched and manipulated to correct position and held in place with long legged cast. Every week the process of stretching, re-position, and casting is repeated till the foot is improved. The improvement takes about 6 to 8 weeks.
- Achilles tenotomy- After going through manipulation and casting, 90 percent of babies need minor procedure to release tightness. For this a quick procedure is performed, doctor will take a thin instrument to cut tendon. The cut is very small and will not require stitches. New cast will be applied to protect the tendon during healing process. It takes about 3 weeks to heal. By the time cast is removed, the achilles tendon regrow to proper length and clubfoot is cured.
- Bracing- After successful correction, the clubfoot can recur. To ensure, foot is completely corrected, baby will have to wear braces for few years. The brace will keep the foot at correct angle to maintain correction.
- Considering Ponseti Method- The ponseti method is extremely effective for most of the children . It require high commitment from family to apply the braces properly every day.
The child’s foot is partially corrected with stretching and casting, then to fully correct the club foot, following kind of surgery-
- Less extensive surgery- It will target those tendon and joints which are helping in deformity. This include releasing of tendon at back to inside of mid foot.
- Major reconstructive surgery- It involve extensive release of multiple soft tissue structure of foot. Once the correction is made, joints of foot are stabilized with pins and long-leg cast while the soft tissue heals. After 4-6 weeks doctor will remove pins and cast. A short leg cast is applied, which has to be worn by the child for 4 weeks. When the cast is removed, there is still chance of clubfoot to return, s special shoes are used for a year after surgery.
- If mother smokes during pregnancy.
- If you have spina bifida or other spinal injuries.
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