Clubfoot also known as Congenital Talipes Equinovarus describes a position of the foot a baby is born with. The foot is turned under and towards the other foot. When broken down into its parts, equinovarus means that the toes are pointed down (equinus) with the ankle flexed forward (like the position of the foot when a ballet dancer is on her toes). Varus means tilted inward. The ankle is in varus when you try to put the soles of your feet together.
This twisted position of the foot causes problems. The ligaments between the bones are contracted, or shortened. The joints between the tarsal bones do not move as they should. The bones themselves are deformed. This results in a very tight, stiff foot that cannot be placed flat on the ground for walking. To walk, the child must walk on the outside edge of the foot rather than on the sole of the foot.
Clubfoot is not a rare or new condition. This condition has been described in medical literature since the ancient Egyptians. Congenital means that the condition is present at birth and occurred during fetal development. The condition affects both feet in about half of the infants born with clubfoot. Clubfoot affects twice as many males as females.
For a long time, treatment was with surgical correction. But according to the results of a recent survey, there has been a shift toward less invasive, nonsurgical treatment. Specifically, surgeons are using an approach referred to as the Ponsetti method. This method involves manipulation and casting.
This type of treatment is started as soon as possible. The foot is manipulated (moved) 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.
According to the Pediatric Orthopaedic Society of North America (POSNA), the majority of pediatric orthopedic surgeons use the Ponseti method with good results. They say it takes about seven weeks on average to correct the foot position. About one-fourth of their cases relapse (go back to the clubfoot position). In cases of relapse, minor surgery (release a tendon) might be needed. Only about seven per cent of the children ever need extensive reconstructive surgery.
Ten years ago, the Pediatric Orthopaedic Society of North America (POSNA) surveyed their members about their treatment of clubfoot. This same survey was repeated recently showing some changes in treatment over the last 10 years. For example, some surgeons have given the task of casting the children to their staff and they use synthetic (fiberglass) materials instead of the old, heavy plaster casts.
The casts are placed on the entire leg (not just the lower leg and foot) and changed about every seven days. Bracing is used by 99 per cent of the surgeons after cast treatment. Different types of braces are available with no consensus on which one is the best. The length of time bracing is used varies from one year to more than four years. This is a change from 10 years ago when bracing was used for less than one year.
The results of this survey show a trend in the treatment of clubfoot toward almost exclusive use of the Ponseti method. There are several reasons for this shift. First, studies have reported excellent long-term results to support the use of this treatment approach.
Second, parents are using the Internet to search for information on clubfoot and asking about less invasive ways to treat it. And third, the method is being taught in medical school so surgeons have a better understanding of the treatment and use it routinely.
One other shift in philosophy has been reported and that has to do with the tendon releases being done. More surgeons are performing this procedure with the child under general anesthesia rather than local anesthesia. The reason(s) for this were not reported.