Clubfoot is a painless congenital deformity in which the baby’s foot is spotted in an inward position. In rare conditions, the bottom of an infant’s foot severely turns upwards or sideways. However, clubfoot needs immediate treatment after birth; otherwise, it will remain deformed, and the child may find difficulty in walking. 

In maximum cases, the doctors have seen successful recovery through non-surgical methods that need a combination of stretching, casting and bracing. Clubfoot is usually diagnosed at the time of the birth; in some conditions, it might be witnessed during a prenatal ultrasound. However, the treatment needs to begin shortly after the child’s birth.

Causes

Till now, the cause behind the clubfoot is undiscovered. It is believed that the condition may occur due to genetic or hereditary factors. Mainly the risk is associated with a male child even in the case of family history. Clubfoot is witnessed in about 1 out of every 1000 births.

Treatments for Clubfoot

Treatment procedures associated with clubfoot help obtain recovery faster, enabling them to perform daily routine activities without any discomfort. Both surgical and non-surgical methods are applied according to the condition of clubfoot. Below methods are being used for Clubfoot Treatment in India.

• Nonsurgical Treatment

Generally, doctors prefer to treat Clubfoot with the non-surgical method regardless of the severity of the deformity. Today the most popular and effective non-surgical method is the ‘Ponseti Method.’

• Ponseti Method

In this procedure, the doctor will gently stretch and apply rounds of the cast to gradually correct the position of the affected clubfoot leg. The treatment is shortly begun after the child’s birth, within a few weeks. Here is the brief of performing Ponseti Method;

• Manipulation and Casting

The baby’s foot is softly stretched and manipulated into the correct position by the surgeon. A cast will be applied from toes to thighs for a week to 10 days. The process will go on for 6 to 8 weeks, where the doctors will gradually stretch, re-position, and apply cast in each session until the baby’s leg is improved to the right position. 

• Achilles Tenotomy

In most cases, doctors need to perform a minor procedure Achilles Tendon (heel cord), in which the tightness of muscles is released. A small incision will be made to cut tendon in a quick process, which even doesn’t require stitches. Along with it, a new cast is placed to fix the position and protect the tendon until it heals. This time the cast will be applied for more than 3 weeks as it will take time for Achilles tendons to regrow and repair in a longer length. Once it is healed, the cast is removed, and 90% of the clubfoot is considered to be corrected.

• Bracing

Lastly, bracing is required to ensure the correct position’s stability for a lifetime, as clubfoot has a natural tendency to recur. These braces must be fixed for a few years and customized according to the improvement in child’s movements with age. These bars/ braces help keep the foot at the right angle to maintain the correction and support walking.

Initially, the baby needs to wear braces for 24 hours; then, the doctor will gradually decrease the duration into 12 hours or overnight. The bracing will continue up to 3 to 5 years of age. In the beginning, the child will show discomfort with the braces but finds adjustment soon. The parents need to learn precautions and maintain hygiene around braces; otherwise, there might be a chance of infection around the instrument.

• Surgical Treatment

Surgical treatments are recommended in cases where non-surgical methods fail to deliver the positive outcomes in the first place or deformity returns in a short span. Also, some children are born with the severe condition of clubfoot that does not respond to stretching ultimately requiring surgery to get corrected. 

Sometimes, the clubfoot gets partially corrected with stretching and casting and requires a small procedure of surgery to get full recovery. 

In less extensive surgery, the surgeon will perform anterior tibial tendon transfer, which involves releasing Achilles tendon at the back of the ankle. Or in other processes, the tendon that moves from the front of the ankle to inside the midfoot is moved. The wound is covered with cast and gives some time to heal.

Another procedure is Major reconstructive surgery that needs the release of multiple soft tissues of the clubfoot. Once the leg is positioned in the correct direction, the joints are stabilized with pins and supported with the long-leg cast until the tissues are healed naturally.

The cast and pins will be removed within the span of 4 to 6 weeks, and then another cast is applied for 4 weeks (in shorter length). Once the clubfoot is corrected, braces will likely be recommended to restrain the recurrence of clubfoot. After performing the surgical method, braces are needed to be applied for at least a year. 

Outcomes of Treatment

Clubfoot cannot get better on its own; parents need to go for the recommended treatment as soon as possible. With precautions and strict care, the child can lead a healthy life while performing daily activities and participating in sports wearing regular shoes and footwear. As a result, the child may experience a slight difference in the affected leg and a normal one, but that is rarely a significant issue.