Clubfoot correction in Children – Can It be Easily Corrected?

Can Clubfoot be corrected?

Clubfoot is a congenital deformity which can occur to one out of every 1,000 babies. It can form any abnormal shape where either toe curls sideways, bent at a certain angle, crooked appearance, points in the wrong direction or even nearly upside down. In most cases, babies born with clubfoot are found in good condition in overall health. Clubfoot can be found in one or both feet and is painless. It needs to be treated so that the child may not feel uncomfortable or bear troubles to walk.

 In another name, clubfoot is also known as ‘talipes equinovarus’ (TEV) where the tissues connecting the muscles to the bone are detected as shorter than usual. A pediatric orthopedic will check and inform if the condition is mild or severe; in both cases, it is recommended to treat as soon as possible after birth. 

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Generally, it is easy to correct Clubfoot successfully without performing surgical methods and children don’t have to go through lots of medical treatments in the longer run. Whereas in some cases surgery is required and some later follow-ups to check the progress of the corrected foot. 

Symptoms of Clubfoot

Clubfoot can be recognized in the early stage, even before the birth of the child. Here’s are the few hints;

• The affected foot or leg of a child may be slightly shorter than the other;
• In some cases the calf muscles of clubfoot are founded to be underdeveloped;
• Sometimes, the foot is severely twisted making it look like upside-down;
• Top of the foot is either turned downward or inward.

All of the positions mentioned above describe the clubfoot conditions and do not cause any discomfort or pain to the child. 

Treatment for Clubfoot

An infant born with clubfoot is medically examined before further treatment if he or she is healthy or not (which is the rarest case). Once clubfoot is treated, the child is assured of having a regular routine and active lifestyle with any complications. 

Majority of cases are corrected just after the birth in about 6 to 8 weeks with the help of proper some gentle manipulation practices and rounds of application of casts. The treatment begins after understanding the functional anatomy of the affected foot(s) and its response to connected muscles, ligaments, tissues and bone (tendons) when correcting it into the right position. Doctors prefer manipulation and casting in mild cases of clubfoot, which takes about a month and a half in the process but has effective results. 

In general cases, the treatment starts at two weeks of age which is preferable by the doctors, as it is easy to find favorable elasticity of the tissues forming the ligaments joint capsules and tendons. 

Applying the widely known Ponseti Method, the affected structures of the foot are stretched and manipulated by the experts on a weekly basis. A cast is used on each session to retain the new corrected position and to soften the ligaments. It’s a gradual process where foot bones are brought into correct alignment.

Five to seven casts are applied to the child from the toes to the upper thigh placing the knee at the right angle to correct the deformed foot. At times the foot becomes stiff at the wrong position which needs more rounds of casting but still can be corrected in less than 10 rounds.

Only the last application of cast is required to be worn for around three weeks. During this period the doctors usually cut the Achilles tendon to complete the correction of the foot. It is expected that tendon will regenerate in its time and grow into proper length by the time the last cast is removed. Depending upon the condition, the doctor can even shorten the procedure by changing the plaster cast every five days. 

Once the casting is done, bracing is necessary to support the correct position of the foot, and also it prevents the chances of relapsing of the clubfoot. Doctors will place a full-time splint for about two to three months, and after that, it will be placed during the night hours up to to 3 to 5 years of age. The brace is designed with attached shows that have 60 degrees of abduction at the end of the bar.

At the initial stage, the baby may feel uncomfortable, but soon he/she will learn to kick legs simultaneously without feeling much trouble. During the day time, children can wear regular shoes, but they have to perform activities with precautions. 

Once the bracing period is completed, the simplest operation is required when the child reaches the age of 3 to 4 years of age. Not all children have to go through the surgery as it is needed when doctors have to transfer the anterior tibial tendon to the third cuneiform.

For the Ponseti Method, the process of bracing is to be done under the doctor’s surveillance for a longer period, so that the foot doesn’t return to its deformed position. However, the procedure is quite risky if it is not directed by experts or braces are not used properly.

Surgery for Clubfoot

In a severe condition of clubfoot, the baby’s foot will not adapt or respond to non-surgical treatments, and for those conditions, more-invasive surgical methods are opted by the doctors. An orthopedic surgeon will study the case and perform the lengthening or repositioning of tendons and ligaments to ease the foot into the right position. 

After the surgery is performed successfully, a child will be applied with a cast for a month or two. Also, a brace will be worn for around a year to prevent the previous position of the foot. If the surgery is performed in the early days, then the child can lead a full active routine, wearing ordinary shoes and footwear for the rest of the life. 

Conclusion

Clubfoot is a treatable deformity and can be healed at a very early age as the infant has flexible joints, ligaments and bones. The treatment for the clubfoot usually begins within the first two weeks of the birth of a child. For doctors, the only goal of treatment is to improve the position and functioning of a child’s feet so that he or she can learn to walk like healthy children and also they must be prevented from other long-term or bone disabilities.