Child Orthopedics

Frequently Asked Questions

Our six-month old had surgery to correct a clubfoot position of both feet. That was three months ago. It didn't work so they have to start over. Does the second surgery usually take care of the problem?

Clubfoot means that the toes are pointed down and the feet are turned inward toward each other. The ankle is in varus when you try to put the soles of your feet together. The most commonly used treatment in the newborn and infant for this problem is manipulation and casting. This is started as soon as possible. The greatest chance for correction of deformity occurs early in life when there is so much growth occurring. The foot is manipulated 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 or surgery is performed. The success of treatment of clubfoot by manipulation and casting alone varies greatly. The majority of infants will eventually require surgery. But, the manipulation and casting begins the process of guiding the foot towards a more normal form. In the infant that eventually needs surgery, the manipulation and casting are still required to obtain as much correction as possible prior to the surgery. When it is clear that manipulation and casting alone will not result in success, surgery will be recommended by your surgeon. The main question is when to perform the surgery. The earlier the surgery is performed, the more growth remains in the foot. The more growth remaining, the more the deformity can be corrected. But, a smaller foot is much harder to operate on effectively. The surgery is much harder and the risk of damage to the nerves, blood vessels, and bones is much higher. Most surgeons recommend waiting until the foot is about eight cm (three inches) long. This usually occurs when the infant is about nine months old. Most surgeons agree that it is ideal to have the surgery over and healed before the infant starts to try and walk. Surgery performed at nine months usually will accomplish this as well.

Stephanie Boehm, MD, et al. Early Results of the Ponseti Method for the Treatment of Clubfoot in Distal Arthrogryposis. In The Journal of Bone and Joint Surgery. July 2008. Vol. 90-A. No. 7. Pp. 1501-1507.

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