Child Orthopedics

Frequently Asked Questions

Our granddaughter was born with two problems: clubfoot and something called arthrogryposis. The doctors are urgently recommending surgery. Our son and his wife want to wait-and-see what happens. They just can't bear to have their first baby operated on. We're not sure how to advise them. What's best in this situation?

Arthrogrypotic clubfoot deformity can be difficult to treat without surgery. The tight, inflexible joint from arthrogryposis combined with the turned in foot position of the clubfoot present quite a treatment challenge. Studies support early surgery to correct both problems. A new report from the Washington University School of Medicine was recently published on this topic. The researchers used the Ponseti method usually used with clubfoot on a group of 12 infants with arthrogrypotic clubfoot. In the past, multiple surgeries to release the soft tissues around the contracted foot have been the main treatment for clubfoot associated with Arthrogryposis. Scar tissue often prevents a good outcome and results in repeated surgeries. The Ponseti method combines a soft tissue release of the Achilles' tendon with serial casting followed by bracing. Serial casting means the foot is held in as neutral a position as possible then put in a cast to hold it there. Once the foot accepts this new position, the cast is removed and replaced with a new cast. Again, the foot is moved to a more neutral position and recast. This process is repeated until a normal ankle and foot position is achieved. That's when the treatment switches from casting to bracing. The initial surgery to release the tendon is very simple and can often be done as an outpatient with only a local anesthetic. This is a minimally invasive way to accomplish the first step of the treatment procedure. If the surgeons have not considered this approach, it may be worth asking about possible alternatives to the more traditional surgery for arthrogryposis.

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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