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Clubfoot Correction Preferred method in India

Released Date : 2024-08-10

Clubfoot Correction Preferred method in India



What is a Clubfoot?

Clubfoot is also known as congenital talipes equinovarus, is a birth defect condition where a baby is born with one or both feet turned inward and downward. The condition is relatively common and affects about 1 in every 1,000 births.

Treatment in Congenital Clubfoot Deformities 

Treatment for clubfoot usually begins in the first week or two after birth. The goal of treatment is to improve the way your child's foot looks and works before he or she learns to walk, in hopes of preventing long-term disabilities.

Treatment options include:

  • Stretching and casting (Ponseti method)
  • Surgery

Non Surgical Method to Correct Clubfoot deformity, also known as congenital talipes equinovarus, can be effectively treated using non-surgical methods, especially when diagnosed and treated early. The most common and successful non-surgical treatment method is the Ponseti Method. Here’s how it works:

Ponseti Method

  1. Serial Casting:

    • The treatment typically begins shortly after birth, ideally within the first few weeks of life.
    • The baby’s foot is gently manipulated into a more correct position, and a cast is applied to hold the foot in place.
    • The cast is changed weekly or bi-weekly, with each new cast further correcting the foot’s position.
  2. Achilles Tenotomy (if needed):

    • In most cases, the Achilles tendon (heel cord) becomes tight and needs to be lengthened.
    • This is usually done through a minor, quick procedure called a percutaneous Achilles tenotomy, often performed under local anesthesia.
    • After the tenotomy, a final cast is applied for about three weeks.
  3. Bracing (Foot Abduction Orthosis):

    • Once the final cast is removed, the child will need to wear a special brace, typically referred to as a foot abduction brace or boots-and-bar.
    • The brace is usually worn full-time (23 hours a day) for the first 3 months, and then during naps and nighttime sleep for a few years to prevent recurrence.

Option 2 : Tenotomy  A Surgical Approach to repair Clubfoot Deformity 

A tenotomy is a surgical procedure that involves cutting a tendon. It's commonly used to correct various musculoskeletal conditions, including clubfoot.

Achilles Tenotomy in Clubfoot Treatment

In the context of clubfoot, a tenotomy is often performed on the Achilles tendon, which is located at the back of the ankle and connects the calf muscles to the heel bone. Here's how it works:

Why is Achilles Tenotomy Necessary?

  • Tendon Tightness: In many cases of clubfoot, the Achilles tendon is too tight and prevents the foot from achieving the correct position, even after serial casting.
  • Final Correction: The tenotomy allows for the final correction of the foot's position, especially in achieving the proper upward movement (dorsiflexion) of the foot.

Procedure

  • Minimally Invasive: The procedure is usually quick and minimally invasive. A small incision or puncture is made through the skin at the back of the ankle.
  • Local Anesthesia: It is often performed under local anesthesia, especially in infants, to minimize discomfort.
  • Cutting the Tendon: The surgeon makes a small cut in the Achilles tendon, which allows the foot to be brought into the correct position.
  • Casting: After the tenotomy, a cast is applied to the leg to hold the foot in its corrected position. The cast is typically worn for about three weeks.

Recovery

  • Healing: The Achilles tendon heals relatively quickly after the procedure, typically within a few weeks. During this time, the tendon regrows to its proper length, allowing the foot to stay in the corrected position.
  • Bracing: Once the cast is removed, the child will usually need to wear a brace to prevent the foot from returning to its original position and to maintain the correction.

Benefits

  • Effective Correction: The Achilles tenotomy is a key step in the Ponseti method for treating clubfoot and is highly effective in achieving long-term correction of the deformity.
  • Minimal Scarring: Because the procedure is minimally invasive, scarring is usually minimal, and recovery is quick.

FAQ: Clubfoot (Congenital Talipes Equinovarus)

1. What is clubfoot?

  • Answer: Clubfoot, or congenital talipes equinovarus (CTEV), is a birth defect where one or both feet are twisted inward and downward. It occurs due to abnormal development of muscles, tendons, and bones in the foot and lower leg.

2. How common is clubfoot?

  • Answer: Clubfoot affects approximately 1 in 1,000 live births. It is more common in boys than girls and can occur in one or both feet (bilateral clubfoot).

3. What causes clubfoot?

  • Answer: The exact cause of clubfoot is unknown, but it is believed to involve a combination of genetic and environmental factors. In some cases, it may be associated with other conditions, such as spina bifida.

4. Can clubfoot be detected before birth?

  • Answer: Yes, clubfoot can often be detected through prenatal ultrasound as early as the second trimester of pregnancy. However, a definitive diagnosis is usually made after birth.

5. What are the treatment options for clubfoot?

  • Answer: The primary treatment for clubfoot is non-surgical and involves the Ponseti method, which includes gentle manipulation of the foot and casting. In severe cases or when non-surgical methods are not fully successful, surgical intervention may be needed.

6. What is the Ponseti method?

  • Answer: The Ponseti method is a non-surgical treatment involving the gradual manipulation and casting of the foot to correct its position. It typically starts soon after birth and includes a series of weekly casts, followed by a minor procedure called an Achilles tenotomy, and the use of a brace to maintain the correction.

7. Is surgery necessary for clubfoot?

  • Answer: Surgery is not usually the first line of treatment. Most cases of clubfoot can be successfully treated with the Ponseti method. However, in cases where non-surgical methods are not fully effective, surgery may be necessary to correct residual deformities.

8. What is the prognosis for children treated for clubfoot?

  • Answer: With early and appropriate treatment, most children with clubfoot can achieve near-normal or normal foot function. They can walk, run, and participate in sports. However, regular follow-up is necessary to monitor growth and prevent recurrence.

9. Can clubfoot recur after treatment?

  • Answer: Recurrence can occur, particularly if the bracing phase of the Ponseti method is not followed as recommended. Continued use of a brace or special shoes is crucial in the first few years after treatment to maintain the correction.

10. How long does the treatment for clubfoot take?

  • Answer: The initial phase of treatment with the Ponseti method usually takes 6-8 weeks of casting. Afterward, the child will need to wear a brace for up to 23 hours a day for 2-3 months, followed by night-time bracing until about 4-5 years of age.

11. Is clubfoot painful for the child?

  • Answer: Clubfoot itself is not painful, but without treatment, it can lead to pain and difficulty walking as the child grows. The treatment process, especially the manipulation and casting, is generally well-tolerated by infants.

12. What happens if clubfoot is left untreated?

  • Answer: If left untreated, clubfoot can result in significant physical disability, including difficulty walking, pain, and limited mobility. The foot may remain twisted, and the child may walk on the side or top of the foot, leading to sores and other complications.

13. Can children with clubfoot lead normal lives?

  • Answer: Yes, with proper treatment, most children with clubfoot can lead normal, active lives with little to no physical limitations. Early intervention is key to achieving the best outcomes.

14. Are there any long-term complications associated with clubfoot?

  • Answer: While most children do very well with treatment, some may experience minor differences in foot size or calf muscle strength. Regular follow-up care is essential to monitor and address any potential issues.

15. Can clubfoot be prevented?

  • Answer: There is no known way to prevent clubfoot, as the exact cause is not fully understood. However, early detection and treatment can prevent the condition from leading to long-term disability.

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