A. ‘Clubfoot’ is a condition in which a baby’s foot is twisted inwards and downwards.
Q. Why does clubfoot happen?
A. In most cases, clubfoot is ‘idiopathic’, which means, the cause is unknown. In some children, clubfoot can be due to disorders of the spine or due to weakness of the nerves and muscles in the legs. Such children are said to have ‘syndromic’ clubfoot.
Q. How common is clubfoot?
A. Clubfoot is one of the commonest birth anomalies. It occurs in about 1 to 2 babies per 1000 births. It is 2.5 times more common in boys. In more than half the children affected, both feet are involved.
Q. Will it get better on its own?
A. No. Without treatment, the foot will remain in the abnormal position, and the child will have trouble in walking.
Q. How is clubfoot treated?
A. Clubfoot is treated with ‘Ponseti Method’ which is essentially non-surgical method. The first part of treatment consists of a series of plasters applied by your doctor to the child’s foot and leg. This is called ‘Ponseti casting’. These plasters or casts are applied once a week. With each cast, the position of the foot is slowly corrected to near normal. In most children, after 4 to 5 casts, a minor surgical procedure is required, to stretch out a tight tendon called the ‘Achilles tendon’ which lies behind the ankle. After this procedure, the final cast is applied, which is only removed after 3weeks.
The second, and equally important part of the treatment, consists of maintaining the correction achieved by wearing a brace.
Q. How long does this treatment take?
A. The initial treatment with casts usually takes 5 to 6 weeks, followed by the final cast for 3weeks. The brace must initially be worn for 23 hours a day for first three months, and then eventually just at night and nap times for 4 to 5 years.
Q. Will major surgery be required?
A. Children with ‘idiopathic’ clubfeet usually do not require any major surgery, as long as they are treated early, within the first few months after birth.
Sometimes, surgery may be required as a part of the initial treatment itself. This is usually for children with ‘syndromic’ clubfeet, or for children who receive treatment when they are older and have started walking on the deformed feet.
Sometimes, a child who’s feet have been corrected well with Ponseti casting may develop some minor issues after some years, such as the feet turning inwards only while walking. In such cases, a surgery is sometimes need to re-direct certain tendons or to release tight soft tissues in the foot.
Q. Will my child be able to walk, run and play?
A. Yes. Most children with clubfoot are able to perform all activities, just as well as their peers.
Q. Will the foot look normal?
A. The foot with clubfoot is usually slightly smaller than the normal side. The calf of the affected side is also usually smaller than the other side. However, after treatment, the shape of the foot will be like normal.
Q. Is the treatment painful?
A. In general, the treatment does not cause any pain to the child. They may have some discomfort initially due to the cast, but they soon become used to it.
Q. What if my child doesn’t wear the brace afterwards?
A. It is very important that your child uses the brace properly, so as to maintain the feet in the corrected position. If the brace is not worn regularly, there is a high chance of recurrence of the clubfoot, which may then require further treatment, including surgery.
Tips for successful brace use
There are various types of braces used to maintain correction of the foot after casting. All types have a shoe for each foot, connected to each other by a rod. Even if only one foot was affected, it is necessary to keep both the feet in the brace in order to maintain correction.
Care of feet in the brace
- Place a soft cotton sock on each foot prior to applying the brace. Cut of the end of the sock so that you can observe your child’s toes while in the brace.
- Remove the brace completely and check your child’s feet all around for any redness or skin irritation. This must be done at least 3 to 4 times a day.
- The brace should be applied firm enough so that the heel rests on the base of the shoe, but not so tight that the toes turn white or the skin is injured.
- The bar in between the legs is an essential component of the brace. Without it, the brace will not serve its purpose. Remember, applying the shoes only, without the bar is as good as not applying the brace at all.
- Check the brace regularly for fitting and breakage. If your child’s toes are curling over the front edge of the brace, the brace is too small and needs to be changed.