Clubfoot

The 'gold standard' method of correcting congenital talipes equinovarus (CTEV) or clubfoot is the Ponseti Method of serial casting and bracing which has a success rate of over 95%. Compared to surgery, which must be repeated several times during growth, the Ponseti method  results in a 100% normal quality of life whereas if you choose the surgical option your child will never achieve a normal gait.

An otherwise normal foot may turn into a clubfoot any time from the 2nd trimester of pregnancy up until the age of 5. There are theories, but no one knows the reason why this happens. It should not be viewed in any way as being the fault of the parents.

Treatment of clubfoot usually 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 better alignment over a period of 6–8 weeks. Each manipulation is 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 manipulations.

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 progressively brought into correct alignment with their joint surfaces and remodeled maintaining their congruency.

  Sintia Lestari - No.7 Cast

 

Sintia Lestari - No.7 Cast

Sometimes a tenotomy is performed 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). After 3 weeks the tendon has rejoined and the cast is removed.

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). The brace is worn for 23 hours per day for 3 months. After that it is worn for 12–14 hours per day mainly during sleeping for the next 2 to 4 years.

Ponseti Method Outcomes

After two months of manipulation and casting the foot appears slightly overcorrected - after a few weeks in splints however, the foot looks normal.

Children are adept at learning new ways of getting around in the brace - they can sit, crawl and walk in the brace. None of the milestones in their development are adversely affected.

In rare cases some children require a surgical procedure at around 3 years which may involve re–locating a tendon in the foot to make it pull more laterally.

After 4 years the brace can be discarded altogether and your child’s feet will be corrected without the need for major surgery. There’s no scare tissue, no reason to expect pain, arthritis or stiffness. Instead your child can look forward to normal, pain free and completely functional feet.

Does surgery "cure" clubfoot?

No. If ’successful’ it improves the appearance of the foot but diminishes foot and leg muscle strength causing pain and stiffness in the second or third decade of life if not earlier.

A 50 year follow up study of the Ponseti Method compared with surgery shows a quality of life equivalent to normal compared with that of a Parkinson’s sufferer for the post surgical clubfoot.

  Right on grandma's hip is Sintia Lestari. Left on Mum's hip is her nephew - another clubfoot baby.

 

Right on grandma's hip is Sintia Lestari. Left on Mum's hip is her nephew - another clubfoot baby.

Indonesia has about 8,500 new clubfoot cases per year - 2 per 1,000 live births. Approximately 40% of cases are bilateral (both feet are affected). 75% of CTEV kids are boys. There is a 1 in 35 chance that a second child in the family will also have clubfoot.