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Clubfoot is a congenital condition that affects approximately 1 out of every 1000 newborns. It involves an abnormal twisting of the foot, causing it to turn inward and downward. While the condition primarily affects the feet, most babies born with clubfoot are otherwise healthy, and around half of these cases involve both feet.
Clubfoot does not cause any pain during infancy, but early treatment is crucial to prevent long-term disability and ensure the child’s quality of life. Thanks to specialised treatments involving stretching, casting, and bracing techniques, most children can achieve outcomes with minimal signs of deformity remaining. This therapy typically begins shortly after birth to ensure the best results.
Regardless of the severity, treatment for clubfoot always commences with non-surgical methods, offering effective solutions in many cases. Two commonly used approaches are outlined below.
Ponseti Method
The Ponseti Method, renowned globally, revolves around gentle stretching and moulding while using casts. This method gradually corrects existing deformities and is highly successful. However, its effectiveness relies on the family’s dedicated commitment to the daily application of braces. Failing to maintain this routine can lead to the reoccurrence of clubfoot.
Even with consistent bracing, some children might experience occasional relapses. If the foot slides out of the orthotic regularly, it could signal a minor relapse in the condition. In such cases, prompt intervention often restores the desired outcome through serial casting or, in rare instances, minor surgery.
French Method
Another non-surgical alternative is the French method, a physical therapy-based approach. This technique involves manipulating, stretching, and wrapping the affected foot with adhesive tape under the guidance of a specialised physical therapist.
Like the Ponseti Method, the French Method requires active participation from families to achieve optimal outcomes. Daily foot manipulation, adjustment, and taping are essential. These steps are reinforced by using a plastic splint to maintain the improved range of motion. The child’s physical therapist will provide guidance to parents, enabling them to effectively follow this daily routine at home and reduce the need for frequent visits.
Typically, infants treated with the French Method see significant improvements in foot positioning within three months. Regular visits to a physical therapist are no longer necessary. A minor Achilles tendon cut procedure may be necessary for these infants, as is commonly done for children treated with the Ponseti method, to enhance ankle dorsiflexion (ankle flexibility). To prevent the recurrence of clubfoot, it is important for families to keep up their daily routine of stretching, taping, and splinting until the child turns two or three years old.
In most cases, clubfoot can be corrected without surgery by following a carefully designed treatment plan. However, in some severe cases, stretching alone is not effective, and adjustments to tendons, ligaments, and joints are needed to achieve correction. Unfortunately, adhering consistently to the rigorous treatment programme can be challenging for parents, which may lead to incomplete or relapsed correction.
We strive to correct a child’s clubfoot using non-surgical methods whenever possible, as surgical approaches can often lead to increased stiffness. Even for individuals with severe deformities or those affected by neuromuscular conditions, stretching and casting can contribute to partial correction without resorting to surgery. This significantly reduces the likelihood of needing surgical intervention for complete correction. However, in some cases, surgery remains the best choice to achieve optimal outcomes for those dealing with clubfoot.
Less invasive options
To target the specific tendons and joints responsible for the deformity, less invasive surgical procedures are commonly employed. This might include loosening the Achilles tendon at the rear of the ankle or repositioning a tendon that connects from the front of the ankle to the midfoot, known as an anterior tibial tendon transfer.
Major reconstructive surgery
For significant clubfoot reconstruction, a comprehensive procedure is performed, involving the release of multiple soft tissue components within the foot. After successful correction, pins and a long-leg cast are commonly used to keep the foot joints stable during the healing process.
Around four to six weeks later, the doctor will remove the pins and cast, replacing them with a short leg cast for an additional four weeks. However, even after the final cast is removed, there is still potential for the foot muscles to revert to their original clubfoot position. To counter this, special shoes or braces might be recommended for up to a year or more after surgery as an additional precaution.
For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.
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Professor Munjed Al Muderis is an orthopaedic surgeon and a clinical professor at Macquarie University and The Australian School Of Advanced Medicine. He specialises in hip, knee, trauma and osseointegration surgery. He is a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group of Australia.