Questions and Answers about Clubfoot and its treatment….

Club foot is common, affecting around 150,000 children worldwide every year – but it can be treated.

What is a club foot?
Club foot is a congenital abnormality of the foot with a combination of deformities like equinus and varus, adduction and cavus. There are lots of different types of club feet related to various medical problems. Club feet are also seen in neurologic or in some musculoskeletal disorders, e.g. cerebral palsy, spina bifida, arthrogryposis multiplex congenital and others.

Is it common among newborn in the UAE?
The most common club foot is the idiopathic club foot which has an incidence of about one to three per 1,000 births. More girls than boys are born with club feet and in about 25 to 50 percent of affected children the club feet are bilateral.

What is the reason for a clubfoot?
Genetic factors and environmental influences during pregnancy might play a role in the development of congenital club foot. There is not a single gene which is responsible for the development of club feet but several genes. Families with a history of club feet have a higher risk to have children with club feet, than families without any history.

The risk is particularly high if both the parents have club feet. These club feet are generally more severe than the sporadic idiopathic club feet.

Would a parent see it straight away?
Usually, most parents can see the deformity directly after birth as the feet are positioned inward, rotated and plantar flexed, and the mobility of the foot is restricted.

If parents are worried about the foot alignment after birth it is recommended to see a paediatric orthopaedic doctor to evaluate the deformity at the same time a general orthopaedic check-up can be done. Nurses and doctors are trained to see deformities and will guide the families to a paediatric orthopaedic doctor for evaluation.

Generally it is always recommended to do a hip screening (with ultrasound) at the age of four to six weeks to rule out other musculoskeletal problems like developmental dysplasia of the hip. In case of a clubfoot deformity this hip screening should be done before starting to treat the foot.

Can the clubfoot deformity be cured?
A club foot can be treated and cured by somebody who is experienced in musculoskeletal problems. The golden standard in club foot treatment is Ponseti Treatment. This method is a non-surgical treatment for correcting club foot. It involves three phases: four to eight weeks of weekly casting, a tenotomy (cutting of the Achilles tendon), which is performed in the clinic, and thereafter cast treatment followed by special shoes connected by a bar.

What is involved in curing it? Is the procedure painful for the baby?
The initial casting procedure is not at all painful for the child. After the initial castings the child undergoes a minor office procedure (tenotomy) done with local anaesthesia. Then a final cast is applied for three weeks. Thus, a baby who is treated from birth will have completed all casting by the age of three months.

When the last cast is removed after the tenotomy, the shoes and bar are applied. The child wears them day and night for four months. After the fourth month they switch to a “night time and nap time only” protocol and wear the shoes and bar only at night and nap time 14-16 hours per day until the age of four.

CONCLUSION: The Ponseti treatment is not painful and will be done with gentle manipulation by a specially trained pediatric orthopaedic surgeon. Usually outcomes in Ponseti clubfoot treatment are excellent if done properly by doctor and the affected family.