Also known as pes equinovarus, it is a disorder of the ligaments, tendons, and muscles in the feet. The foot is inclined inward and upward at the ankle. It is one of the most common birth defects.
Approximately 5,000 babies are born each year in the United States with clubfoot. Males are affected twice as often as girls. They can be on one side or both feet (bilateral). There is currently no way to prevent clubfoot, but it is treatable.
The primary treatment method currently chosen is the Ponseti method, which is a non-invasive method.
Before the Ponseti method, many children underwent complete reconstructive surgeries for correction.
Studies have shown that these surgeries have long-term negative effects on clubfoot patients due to the buildup of scar tissue.
What is the Ponseti method?
The Ponseti method is the standard and currently preferred non-surgical method for treating clubfoot worldwide. It was developed by Dr. Ignacio Ponseti, a Spanish physician. It is a non-surgical method that involves a series of plaster casts to stabilize the foot. This method was not widely used until the 1990s, but it is now considered the best way to correct clubfoot. It is divided into two parts: debugging and maintenance.
Part 1: Correction
Correction begins soon after birth to allow maximum flexibility of the tendons and ligaments, a plaster cast is applied every 5-7 days until you are in the correct position.
Once the foot is in the correct position, an ‘Achilles tendon incision’ (also known as a percutaneous Achilles tenotomy) is performed. The final cast treatment will last approximately 3 weeks while the Achilles tendon heals.
After the final cast is removed, the child is placed in an orthotic (movable splint) brace or “shoe and bar”
Part Two: Maintaining the Correction and Preventing Relapse
Once the final cast is removed, the child will be fitted and placed in their own “boot and boot” brace.
The brace consists of two boots connected by a rod. The typical protocol requires 23 hours of dressing in the first trimester, followed by slow weaning for approximately 14 to 16 hours per day.
The current recommendation is that the brace be worn until age 4 because recurrence rates decrease each year a child wears a brace. The bulk of the time in the brace is at night to maintain the correction while you sleep.
Tenotomy
The Achilles tendon is located at the back of the heel and is short and narrow in club feet and resistant to stretching. As a result, approximately 80-90% of clubfoot children need to release this tendon through a procedure called a percutaneous tenotomy (cutting the tendon through the skin). This is the last step in the debugging process.
The next stage: putting on the shoe with the metal rod
23 hours a day for 3 months.
Weaning slowly for fewer hours until the baby is walking.
Then part-time: during the night and naps, until the child is 4 or 5 years old.
Advice
The width of the bar (the space between the inner edges of the heel of the shoe) should be the width of the child’s shoulders. This distance is comfortable for the child and prevents knee or hip problems. If you place the brace on the floor with the shoe pointing up, the child’s shoulder should fit snugly between the shoe.
External rotation degree (abduction)
The shoe should be at an angle of 60 or 70 degrees to correct clubfoot.
Stretching exercises
Many doctors recommend physical therapy and exercise as a complement to strengthening. Play (like jumping, running, balancing, etc.) is a great way for older kids to get an extra stretch during the day.
In stubborn cases, the surgical treatment option remains the last, as the short tendons are lengthened, the deviated joint capsules are resected and returned to the proper position, and a plaster device is placed after that. He continues with the shoe therapy and exercises described earlier.