Clubfoot

What is clubfoot?
Clubfoot is a congenital deformity of the foot. It results from the abnormal development of the muscles, tendons, and bones in the foot while the fetus is forming during pregnancy. The incidence rate for children born with clubfoot is 1 in 1000. This is the most common birth defect to need intensive orthopedic treatment.

What is the difference between Postural Clubfoot and Congenital Clubfoot?
Postural Clubfoot: In rare cases, clubfoot is just the result of the position of the baby while it is developing in the mother’s womb (postural clubfoot). With light manipulation and casting this is easily corrected.
Congenital Clubfoot: This is a true birth defect, and is more common than postural clubfoot. Although clubfoot is recognizable at birth, the severity of the deformity can vary from mild to an extremely rigid foot that is resistant to manipulation. The collagen of the lower leg and foot are abnormal and this makes congenital clubfoot more difficult to treat.

How is clubfoot corrected?
Clubfoot in an otherwise normal child can be corrected using the Ponseti Method of manipulation and plaster cast applications. Ponseti Method Treatment should begin in the first week or two of life in order to take advantage of the elasticity of the tissues that form the ligaments and tendons in the foot. A small surgical incision is almost always required at the back of the heel. After cast treatment,patients are placed in special orthopedic shoes held together with a “Dobb’s Bar”.

How long will the child need to wear the Dobb’s Bar and shoes?
When the last cast is removed the shoes and bar are applied. The child wears them day and night until instructed by their physician, approximately 9-11 months of age. Then they switch to night time only wear of the same shoes and bar until they are 3 years old.

What if my child doesn’t like or kicks off his/her shoes?
Parents have a very important role once the child is put in shoes with the bar. After the first day or two, infants become accustomed to the shoes and play as normal. Parents may also teach the child to move his or her legs at the same time, making it easier for the child to learn to move about. If parents are not vigilant and strict about keeping the shoes on, the feet might relapse. If parents have continued difficulty keeping the shoes on, they must visit the orthotist for modification.

What is the future like for a child who has clubfoot?
Babies treated using the Ponseti Method will have normal looking feet, with good mobility and function throughout life. The long term outcomes from this method have far exceeded those of surgical treatments. Follow-up studies of clubfoot patients show that children and adults with corrected clubfoot may participate in athletics like anyone else.

“6 month old POBAR patient undergoing successful clubfoot treatment”


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