Club foot is a relatively common condition that is present at birth, where an infant’s foot is turned inward, outward, or, in more severe cases, pointed upward. This condition appears in 1 out of every 1000 infants. Fortunately, treatment is usually successful and can begin shortly after birth. Here is a look at some of the treatment methods that are used for correcting club foot.
Ponseti Method
Sometimes treatment can start as early as 7 to 10 days after birth, at a time when an infant’s bones, ligaments, and tendons are soft and easy to move and manipulate into the normal position. The most common method used for correcting the defect is casting, which is a nonsurgical treatment.
The main form of casting is known as the Ponseti method. This procedure is often attempted first because it has proven to not only be more effective, but also have a better long-term outlook than other methods.
The Ponseti method involves a specialist, most likely an orthopedic doctor, who works with the infant weekly. The doctor gently moves the affected foot into the natural position by slowly correcting the bend in the foot. The infant’s leg is then put in a plaster cast, that encases the whole leg from the toes to the thigh. The cast is changed weekly, and at each casting session the foot is corrected a little more. Usually, 5-6 casts are used, but, depending on the case, more casts may be needed.
Achilles Tenotomy
The gentle, gradual manipulation of the foot is painless for the infant, but in most cases a minor surgery following manipulation is needed. The surgery is necessary to release a tightened Achilles tendon that is often a side effect of casting.
The operation, known as an Achilles tenotomy involves a small and simple cut to the tendon. The leg is then set in a cast that must be worn for about three weeks, or until the tendon heals and has regrown to a proper length.
Bracing
There is a risk of relapse following the correction with casting. To prevent club foot from recurring, a brace, sometimes referred to as “boots and bar", is worn 23 hours a day for the first 3 months after treatment.
The hours in the brace are reduced gradually, until the child is only wearing it during sleeping periods such, as nighttime and nap time. This routine is followed for a few years. Bracing is usually essential for reducing the chances of a relapse.
French Method
The French method is another non-invasive technique that is used in hopes of avoiding surgery. It uses a combination of stretching, mobilization, and taping. It is sometimes referred to as "the physical therapy method" and is normally administered by a physical therapist instead of an orthopedic specialist.
Similar to the the Ponseti Method, the French Method also starts shortly after birth. The infant's club foot must be stretched and manipulated every day. In order to maintain the range of motion that is achieved with manipulation and stretching, the foot is taped then set in a plastic splint between sessions. The physical therapist is seen three times a week, but the parents will be responsible for following the regimen daily.
This method has been shown to improve foot position in as little as three months. To prevent a relapse of club foot, the French method should be used until the child is two to three years old,. However, visits to the physical therapist can be reduced once improvement is seen.
As with the Ponseti method, Achilles tendon surgery is often necessary after using the French method.
Club Foot Repair Surgery
In some cases, surgery is needed because the affected foot is either not fully corrected or returns to its original position. Regardless of the exact cause, in these cases, the tendons, ligaments, bone, and joints in the foot and ankle will need to be adjusted. While this is an invasive procedure, especially for an infant, it is usually a last resort.
