Club Foot The best method of correcting congenital talipes equinovarus (CTEV or club foot) is the Ponseti Method of serial casting and subsequent bracing which has >95% success rate. An otherwise normal foot turns into a clubfoot during the 2nd trimester of pregnancy. There are theories, but no known reason why this happens and it should not be viewed in any way as being the fault of the parents. Treatment of clubfoot normally starts when the child is just a few days old, but it is possible to apply this method through childhood. The foot is gently and gradually manipulated into a more correct alignment over a period of 6–8 weeks and held in position with a new plaster cast applied approximately every 7 days. A series of 6–8 casts may be applied over 2–3 months. The connective tissue, cartilage, and bone respond to the mechanical stimuli created by the gradual manipulation. 
As the foot is moved into the correct position, the ligaments, joint capsules, and tendons are stretched and the foot becomes more flexible. The displaced bones are thus gradually brought into the correct alignment with their joint surfaces progressively remodeled yet maintaining congruency. Sometimes a tenotomy is performed under local anesthetic at the end of the series of plaster casts so that the equines deformity can be corrected. This is a simple procedure which involves severing the Achilles Tendon usually under local anesthetic. The child’s feet are cast again this time in a 25° dorsiflexed position (toes pointing upwards) for about 3 weeks allowing the tendon to rejoin. In order to prevent a relapse, the child has to wear a pair of shoes attached to a metal bar in an abducted position (out–toe overcorrection). This brace has to be worn initially for 23 hours per day for 3 months. The time is then reduced to between 12–14 hours per day mainly during sleeping. |
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