Child Orthopedics

Frequently Asked Questions

Our baby was born with clubfeet. He's so very tiny but they are still insisting he will need treatment with casting and bracing. For now, we move his feet and ankles through the motion that he has. The hope is that we will be able to restore full motion without additional treatment. How does the doctor tell when the treatment has worked?

Clubfoot is a congenital condition that affects newborn infants. The medical term for clubfoot is Congenital Talipes Equinovarus. This condition has been described in medical literature since the ancient Egyptians. Congenital means that the condition is present at birth and occurred during fetal development. The condition is not rare and the incidence varies widely among different races. The condition affects both feet in about half of the infants born with clubfoot. Clubfoot affects twice as many males as females. The physician has a very good idea of what normal anatomy and full range-of-motion should be for infants and young children. He or she will rely on this understanding of normal to treat the clubfoot. The goal is to restore forefoot, hindfoot, and ankle motion needed to stand and walk. One thing they look for is whether the forefoot can be moved away from the midline at least 70 degrees. The hindfoot must also be corrected making it possible to move the calcaneus (heel bone) inward, a motion needed for normal walking. Standard treatment is with a treatment approach called the Ponseti method. The foot is manipulated (moved) to stretch and loosen the tight structures. The foot is then placed in a cast to hold it in a corrected position. This is repeated every one or two weeks until the deformity is corrected. If the hindfoot does not correct fully, the surgeon can perform a percutaneous tenotomy. This is a release of the Achilles tendon through the skin without doing open surgery. After casting and/or tenotomy. The next step is to place the child in a Denis-Browne splint. But it sounds like you are just at the beginning of treatment and may not need these next steps in treating clubfoot. Next time you are in the doctor's office, ask him or her to show you what they are looking for in terms of normal and what it will look like when your child will have the necessary motion. As mentioned, further treatment might be needed. Don't miss any of your follow-up appointments. Children can grow and change rapidly. You'll want to stay on top of any changes that might compromise your child's results. If at any point you feel that the motion you are getting is less than it was, it's time to check in with your physician.

Joseph A. Janicki, MD, et al. Comparison of Surgeon and Physiotherapist-Directed Ponseti Treatment of Idiopathic Clubfoot. In The Journal of Bone and Joint Surgery. May 2009. Vol. 91. No. 5. Pp. 1101-1108.

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