Clubfoot
is a congenital foot condition, which affects approximately
1 out of every 1000 births in the United Kingdom. However,
prevalence of this condition is twice as common in males
than females. The deformity can be mild or severe and
it can affect one foot or both feet. As many as 50%
of cases are bilateral (both feet are affected). Club
Foot is sometimes confused with other congenital foot
defects, such as Calcaneovalgus and Metatarsus
adductus. These deformities are caused by the position
of the foot in the womb and are usually corrected with
minimal intervention. True clubfoot affects all the
joints, tendons and ligaments in the foot and is often
referred to as Congenital Talipes EquinoVarus.
Another form of clubfoot is Congenital Vertical Talus,
this is not as common as true clubfoot, the foot appears
more rigid then a true club foot deformity. In most
cases, clubfoot is idiopathic, which means that the
cause is unknown and there is no genetic tendency. However
it is associated with Spina Bifida and Hip Dysplasia.
APPEARANCE
High
arched foot that may have a crease across the sole
of the foot.
The
heel is drawn up.
The
toes are pointed down.
The
bottom of the foot (heel) is pointed away from the
body. Thus, the foot is twisted in towards the other
foot (please refer to photograph below)
The above photograph is of a Clubfoot
deformity in a child of six months.
The above photograph is of a Clubfoot
deformity in a new born child,
The
foot and leg may be smaller in comparison to a comparatively
normal child.
The
foot will lack motion and be noticeably stiff.
The
calf muscle may also be smaller.
SYMPTOMS
If
left untreated the child will walk on the outer
top surface of the foot.
The
patient may also experience corns, hard skin and
in growing toenails.
Clubfoot
in adulthood can lead to difficulty in purchasing
shoes and a gait abnormality (walking pattern).
WHAT
YOU SHOULD NOT DO
DO
NOT ignore this condition in a hope that it
will spontaneously disappear.
WHAT
YOU SHOULD DO
Seek
immediate advice from a pediatric consultant.
Seek
as many opinions as you can before you commence
a treatment regime.
TREATMENTS
There
are many treatments available for clubfoot and many
different opinions exist concerning treatment regimes.
The
aim of the treatment regime should be: -
Correct
the deformity early.
Correct
the deformity fully
Hold
the correction until growth stops.
Below
is the summary of some of the main conditions.
Casting
This
may be begin from the 1st day of life
to several weeks after birth.
The
foot is pushed and twisted into an over corrected
position by the Orthopedist.The cast is
then applied in order to hold the foot into that
position. This may be uncomfortable for the child.
Casts
are usually changed every two weeks.
Splints
or braces may be used after a few years of casting
the feet.
This above photo of an infant in a
Denis Browne bracing bar after undergoing months of
casting using the Ponseti method as treatment for
his bilateral clubfeet.
He will have to wear the bracing bar for 23 hours
a day for about 3 months and then only at night for
two to four years.
The
Ponseti method of casting and manipulation can also
be effective. This method was pioneered in the 1940's
by Dr Ignocio Ponseti and can be successful in certain
cases. Please refer to your consultant for further
information.
The above photograph is of a Clubfoot
casting.
Click below to watch a video
about
the Ponseti Method
Surgery
There
are many surgical procedures available for clubfoot.
Surgery is usually recommended to a child of six months
old. Below are the list of commonly used surgical procedures.
For further information concerning these surgical procedures,
please consult an Orthopedist.
Perctuneous
tenotomy. The Achilles tendon is cut to allow the
foot to drop.
Posterior
release.
Medial
release.
Subtarsal
release.
Complete
tendon transfer.
Physiotherapy
This
is primarily a non-surgical treatment that can begin
when the child is three months old.
It
involves frequent visits by a physical therapist
who tapes and/or manipulates the foot. This method
has proved highly successful in some cases.
WHAT
THE CHIROPODIST WILL DO
Refer
you to a pediatric consultant or a physical therapist.
In
adulthood, the chiropodist will treat any foot conditions
that may arise due to clubfoot, i.e. Corns.
The
chiropodist may customize insoles or shoes for the
patient.
This swedish company retails Dennis
Browne Bar/ Splint and The Tarso Shoe which is used
for the Ponseti method of treating a club foot. The
shoe has an open toe with 2 threaded holes for connecting
to the Dennis Browne bar. Click on the pdf to view further
details.
