Children’s Clubfoot
Clubfoot is a complex deformity that is readily apparent at birth and in some cases is diagnosed by prenatal ultrasound. The goal of treatment is to obtain and maintain correction of the clubfoot so that the patient has a functional, pain-free, plantigrade foot, with good mobility and without calluses, and does not need modified shoes. Parents of infants born with clubfeet and no other significant medical problems should be reassured that their child when treated by medical experts, will have feet that are fully compatible with a normal, active life.
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Clubfoot In Children
Clubfoot may occur as an isolated disorder (idiopathic) or in combination with various syndromes and other associated anomalies such as arthrogryposis and myelodysplasia. Medical examinations by your doctor or blood tests should be able to determine whether your baby’s clubfoot is idiopathic.
Clubfoot can be mild or severe and all cases require treatment. Clubfoot will not resolve without treatment. The clubfoot is not painful to the infant who does not yet walk.
The incidence of idiopathic clubfoot is estimated to be one to two per 1000 live births. It has a male predominance of 2:1 and occurs in both feet about 50 percent of the time. There is a much higher incidence if the patient has a positive family history of clubfoot.
The etiology of idiopathic clubfoot is unknown. The most widely accepted theory is that clubfoot is caused by a combination of genetic and environmental factors.
Surgical & Nonsurgical Options
Manipulation & Casting
The initial treatment of clubfoot, regardless of severity, is nonsurgical. Manipulation and casting using the Ponseti method is the technique used most frequently in the United States. The majority of clubfeet can be corrected in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts. The technique requires training, experience, and practice. Fewer than 5 percent of infants born with clubfeet may have very severe deformities that are unyielding to stretching. These infants will require surgical correction.
Surgical Treatment
Surgery is indicated if there is a failure to achieve satisfactory clinical and radiographic evidence of deformity correction by nonsurgical methods, for residual deformities, and for recurrent deformities unresponsive to nonsurgical measures. Controversy surrounds the age at which clubfoot surgery should be performed. Most surgeons operate on the child between six months and one year of age.
Though there is some variation in surgical technique, all of the major reconstructive clubfoot surgeries involve extensive soft-tissue release of the posterior, medial, and lateral structures of the foot. The correction, once achieved, is usually held temporarily (six weeks) with wire fixation across the joints of the foot. More surgery is required to remove the wire.
The need for additional surgery after the first operation is reported to range from five percent to 50 percent.
