Clubfoot is a developmental deformity that typically occurs in the second trimester of pregnancy. A newborn’s foot or feet appear rotated internally at the ankle, the foot points down and inward and the soles of the feet face each other. Alongside bone malformations, there are vascular abnormalities, muscle lesions, abnormal muscle insertions and fibrosis within the foot. Clubfoot can occur in otherwise healthy children or it can be associated with various syndromes such as arthrogryposis.
The diagnosis is made intrauterine via ultrasound or through clinical exam after the baby is born. X-rays are not necessary for the diagnosis or management of clubfoot. Clubfoot is associated with a small calf and slightly shortened tibia which can present as a very minimal leg length discrepancy. Classification of a clubfoot is made with respect to the degree of deformity, rigidity, depth of skin creases, and muscle tightness and contractility.
Treatment for clubfoot is started around 2 to 4 weeks of age, or once the child has reached birth weight, with a series of weekly casts that follow the method pioneered by Ignacio Ponsetti, MD. A majority of children will require an Achilles tenotomy at the end of treatment and remain in a cast for an additional three weeks. After three weeks, children are immediately placed into a bar and shoe that they wear 23 hours a day for three months, and then at naps and nighttime until 4 years of age.
Even if parents adhere to this schedule, a small number of children may require surgery, as they get older.
The cast extends from the groin to the toes and is changed every one to two weeks to gently stretch and reposition the foot. The number of casts ranges from four to six.
Phase 2: Tenotomy
The Achilles tendon is clipped to lengthen the heel. This procedure is done in the clinic unless otherwise recommended by your physician. A cast is applied and worn for three weeks.
Phase 3: Bracing
When the final cast is removed, the child is placed in a foot abduction brace designed to prevent the clubfoot deformity from recurring.
At Shriners Children’s Twin Cities, our providers are trained in the Ponsetti method; treatment can start at time of the child’s initial evaluation. On site, we have a dedicated casting room, a child life specialist to help keep children comfortable, and orthotists to ensure proper fit of the foot abduction brace’s bar and shoes at all visits.
About the Author
Michael J. Priola, D.O., is a board-certified pediatric orthopaedic and sports medicine surgeon at Shriners Children’s Twin Cities. His areas of special interest include cerebral palsy, limb deficiencies, foot deformities, spina bifida, sports-related injuries and conditions of the knee. He is proud to be a part of the Shriners Children’s Twin Cities team, which is solely dedicated to the care of children with pediatric orthopaedic conditions.