A Parent's Guide to Clubfoot: Understanding the Orthopaedic Journey

A diagnosis of clubfoot for your newborn can feel overwhelming, filled with questions and uncertainty. But we're here to tell you that clubfoot is a treatable condition, and with the right orthopaedic care, your child can run, play, and live a full and active life. At Limbs Orthopaedic, we specialize in guiding families through this journey, and this post will walk you through what to expect.

What is Clubfoot?

Clubfoot, or talipes equinovarus, is a congenital condition where a baby's foot or feet are turned inward and downward. It's one of the most common birth defects, affecting about 1 in every 1,000 newborns. The exact cause is unknown, but it's believed to be a combination of genetic and environmental factors. It is not caused by anything the parents did or did not do during pregnancy.

The foot's position is fixed because the tendons and ligaments on the inside and back of the ankle are shorter than they should be. While it isn't painful for the baby, it won't correct itself and requires early orthopaedic intervention.

The Gold Standard: The Ponseti Method

For decades, the standard treatment for clubfoot has been the Ponseti Method. Developed by Dr. Ignacio Ponseti, this non-surgical technique has a success rate of over 95% when followed correctly. It's a gentle, minimally invasive approach that corrects the deformity over time.

The method consists of three key phases:

1. Manipulation and Casting (The "Corrective" Phase)

This phase begins as soon as possible, ideally within the first few weeks of life. Here’s how it works:

• Gentle Manipulation: An orthopaedic surgeon or a specially trained physiotherapist will gently stretch and manipulate your baby’s foot to correct the position.
• Casting: After each manipulation session, a long-leg plaster cast is applied, from the toes to the thigh. This holds the foot in its corrected position. The cast is changed every 5 to 7 days, with further gentle correction at each visit.
• Duration: This process is repeated for about 5 to 8 weeks. With each new cast, you will see a gradual but noticeable improvement in the foot's appearance.

2. Achilles Tenotomy (A Minor Procedure)

After the casting phase, most babies (around 80-90%) will need a minor procedure called an Achilles tenotomy.

• Why it's needed: The casting corrects all aspects of the clubfoot except for the "equinus," which is the downward pointing of the foot. This is caused by a tight Achilles tendon.
• The Procedure: The tenotomy is a simple procedure where the doctor makes a tiny incision to release the tight Achilles tendon. It is often done under local anesthesia in a clinic setting and takes only a few minutes.
• Final Cast: After the tenotomy, a final cast is applied and left on for about 3 weeks to allow the tendon to heal in its new, longer position.

3. Bracing (The "Maintenance" Phase)

This is the most critical phase for preventing a relapse. Once the final cast is removed, your child will be fitted with a special brace, often called "boots and bar" (e.g., a Denis Browne bar).

• How it's worn: The brace consists of special shoes attached to a bar that keeps the feet at the correct angle.
• Bracing Schedule:
  • For the first 3 months, the brace is worn for 23 hours a day.
  • After that, it is only worn during naps and at nighttime until the child is about 4 or 5 years old.
• Compliance is Key: It is absolutely essential to follow the bracing schedule diligently. This is the single most important factor in preventing the clubfoot from returning.

The Role of Your Orthopaedic Team

Treating clubfoot is a team effort. Your team will include:

• An Orthopaedic Surgeon: To oversee the treatment, perform the manipulations, and conduct the tenotomy.
• A Physiotherapist: Often trained in the Ponseti method, they may perform the manipulations and casting.
• An Orthotist: A specialist who fits the brace and ensures it is comfortable and effective.
• You, the Parents: You are the most important members of the team! Your commitment to attending appointments and following the bracing protocol is the key to success.

Challenges and Looking Ahead

The most common challenge is relapse, where the foot tries to return to its original position. This is almost always due to not wearing the brace as prescribed. If a relapse occurs, it can usually be corrected with another short series of casts.

With successful treatment, the outlook is overwhelmingly positive. Children born with clubfoot go on to lead completely normal lives. They can walk, run, dance, and participate in sports just like any other child. The treated foot may be slightly smaller and the calf muscle slightly thinner than the other leg, but this rarely causes any functional problems.

A Message of Hope

At Limbs Orthopaedic, we understand that a clubfoot diagnosis can be daunting. But we have seen countless children journey through this process and emerge with happy, healthy feet. The Ponseti method is a marvel of modern orthopaedics, offering a gentle and effective path forward.

If your child has been diagnosed with clubfoot, know that you are not alone and that a bright, active future awaits them.

For more information or to schedule a consultation, please contact us.