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Newborn with clubfootClubfoot is one of the most common congenital birth defects. On average, one in 750 infants is born with clubfoot. Parents of infants born with clubfoot should understand clubfoot is treatable but will require serial casts over several weeks. Neglected clubfoot will cause children physical and emotional pain, and keep them from reaching their full potential as they age. To follow is some information parents should know about clubfoot.

Diagnosis

  • Clubfoot generally starts developing within the first couple of months in the womb.
  • The condition may be diagnosed through routinely scheduled ultrasound, but some parents don’t find out their child has clubfoot until the infant is born. 
  • The cause of clubfoot isn’t entirely clear. It’s suspected to be related to a genetic birth defect, however, often the cause appears idiopathic (the medical term for something that happens from an unknown cause). Clubfoot can be associated with other medical conditions or exist by itself.

Treatment

  • It’s recommended treatment begins within the first few weeks of an infant’s life.
  • The earlier treatment begins the easier it is to stretch the soft tissue and shift bone alignment.
  • The “Gold Standard” of treatment is called the “Ponseti Casting Technique.” This method uses a series of plaster casts that are applied to the child’s feet that cover his or her calves up to above the knees. Every week the cast is taken off, and a new cast is applied.
  • On average, 3-7 castings are applied. These casts gently reshape the soft tissues in the ankles and feet to help realign the bones into a normal functioning position.
  • Before the last cast is applied a small procedure called an Achilles tenotomy is usually done.
  • After the final cast is removed, the child must wear Foot Abduction Braces (FABs) 23 hours a day for the first three months.
  • After the initial three months, the child will slowly be transitioned to wearing the braces for napping and sleeping until the child is between four and five years old. Following through with the braces for years ensures that the child will not suffer a relapse, where the feet turn back into an uncorrected position which can cause pain and limited mobility. We also believe that routine stretching should be to maintain flexibility and function. 
  • The Ponseti Casting Technique is considered the most cost-effective and successful form of treatment.
  • Surgical options for treating clubfoot should only be considered if all conservative measures have been explored. 

Pitfalls in Treatment

  • Using below the knee casts, Ponseti Clubfoot casting requires casts to be from groin to toe. We believe plaster casts are the best as they allow for better molding of the feet preventing slipping and complex clubfoot deformities.
  • Cast slipping. This can be caused by many reasons: a poorly applied cast, the knee not being bent enough, below the knee cast application or usage of fiberglass or soft rolls that do not allow contouring of the foot and ankle. Keep an eye on your child’s toes making sure all toes are visible. Disappearing toes are a sign of cast slippage.
  • Take the time to look at your babies feet after every cast. Take pictures and videos of your child’s feet before casting and throughout the treatment process from all angles. Any new creases or new “deformity” should be alarming and reason to seek a second opinion. Bruising and swelling might also be signs of poor cast application.
  • Make sure you can see the toes and they look pink and well perfused.
  • ENDING BRACING TOO EARLY! Current recommendations are for babies to be in braces (bnb) which are shoes attached to a bar until 4-5 years of age. Ending bracing early can lead to relapse which will require casting and possible surgical procedures.
  • Recurrences are real! When dealing with recurrences we believe children should have serial casting before any surgical procedures are done. If you are being told your child will require invasive surgery seek another opinion.
  • Get informed and familiar with all aspects of treatment, ask questions and seek another opinion if you feel lost and/or overwhelmed.

Was Your Baby Born With Clubfoot? Visit the Southern California Foot and Ankle Specialists for Treatment.

Drs. Rodriguez and Spencer specialize in conditions of the foot and ankle. If you are interested in scheduling an appointment, you may contact them at 949-364-WALK. Their office is located in Ladera Ranch, Orange County. We look forward to meeting you.