8 Years Experience
MBBS, MS (Orthopaedics) FIPO (Mumbai)Consultant Paediatric Orthopaedic & Limb reconstruction surgeon.
Clubfoot (also known as Congenital Talipes Equino Varus) is one of the most common congenital foot deformities in which foot is turned inwards and downwards mimicking a golf club. It can be present in one foot or both feet (in 50% cases) and is more common in males. It can be present as an isolated deformity (Idiopathic clubfoot) or in association with other abnormalities of musculoskeletal system, eg. Arthogryposis multiplex congenita (AMC), Developmental dysplasia of hip (DDH), Metatarsus adductus, Congenital muscular torticollis(CMT), etc. Syndromic clubfeets are more stiffer and complex to correct in comparison to Idiopathic clubfeet.
The exact etiology is still not known and various theories regarding the roles of muscle, bones, neurovascular abnormalities and genetics have been described. Children with clubfeet present with painless deformities of feet which is obvious and can be appreciated by anyone. This deformity is not fully correctible in comparison to the postural clubfoot which does not need treatment.
Treatment: The goal of treatment is to give a well corrected, supple foot to the child. It is mainly divided into casting and bracing phase.
Casting Phase: The good news is that if treatment is started early (preferably within the first week of life), this grosetque looking deformity can be fully corrected with Ponsetti casting treatment within a span of few weeks without any major surgical intervention. At the final cast, a percutaneous Tendoachilles tenotomy is done to correct the equinus. This can be done under local anaesthesia. Ponsetti casting treatment (devised by Ignacio Ponsetti) is one of the most successful and popular treatment with published long term results and is considered the workhorse of clubfoot treatment. It is possible to treat clubfoot in older children, however if not treated early, it can lead to a more rigid deformity which will need soft tissue and bony surgery for correction.
Bracing Phase: After correcting the deformity, child has to wear foot abduction braces for 4 years (as per the protocol) to prevent recurrences which are as high as 50% without braces.
Outcomes: With treatment most clubfeet are correctible and have good function however their foot size and leg girth remains smaller than the normal limb.
Tips for compliance of brace wear:
- Always follow the protocol for brace wear as suggested by your doctor.
- Check for proper fitting of the brace (heel should be properly seated).
- Keep the bar padded
- Encourage your child to play and kick in the brace.
- Check the skin atleast 3-4times in a day for redness and other signs of pressure sore.
- Don’t use any oil or lotion under the shoes.
Dr. Deepak Khurana
