Pediatric Clubfoot: Associated Conditions and Treatment Option

pediatric-clubfoot

What is Pediatric Clubfoot?

Pediatric clubfoot is the congenital disorder that causes the baby’s foot to turn severely in a way that the sole is pointing inwards with the toes pointing down. Although clubfoot is not generally painful it will lead to permanent deformity that affects the child’s ability to walk.

An estimated 1 in 1,000 children are known to suffer from clubfoot making it one of the most common pediatric congenital musculoskeletal disorders. It is necessary to begin treatment of clubfoot as soon as possible to increase the chances of successful treatment and correction.

What are the causes of Clubfoot?

Research has proven to be inconclusive regarding the exact cause of development of clubfoot in a child however many pediatric doctors and experts believe that a combination of environmental and genetic factors play a major role in the development of this disorder.

Clubfoot causes the tendons of the feet, that connect the foot to the leg muscles to become tight and shorten is size, which causes the foot to twist inward. Most feet are mostly affected in a child with clubfoot while boys are found to be at twice the risk of developing clubfoot as compared to girls.

What are some of the associated conditions of Clubfoot?

Clubfoot condition can be from mild to severe and the appearance is mostly similar in all the cases. The foot is generally turned inward with the sole of the foot facing inward and the toes are pointed downwards with a deep crease at the bottom of the foot.

The affected leg will also be shorter than normal with thinner calves due to undeveloped muscles and these signs are more prominent in children with clubfoot in one foot.

There are two types of clubfoot:

Idiopathic (isolated) clubfoot

This is the more common type of clubfoot and occurs as a sole condition with no other related medical problems.

Non-isolated clubfoot

This is a more rare form of clubfoot and is seen due to a combination of various other health conditions, mostly neuromuscular disorders such as spina bifida and arthrogryposis. In case the clubfoot is a non-isolated type condition the non-surgical treatment required to correct it is more extensive or require multiple surgeries as well.

What are the non-surgical methods to treat Clubfoot?

The main non-surgical methods of treatment of clubfoot in children are:

Ponseti method

This is the most common and widely used technique to treat pediatric clubfoot and includes steady stretching and casting to eventually correct the deformity.

Ideally the treatment needs to begin soon after birth to get the best results. The Ponseti method includes:

  • Manipulation and casting – The pediatrician will gently stretch the baby’s foot and manipulate it into the correct position and stabilize it in this position with leg cast that covers the baby’s leg from toes to thigh. The pediatrician will repeat this procedure weekly until the foot shows significant improvement. This procedure requires to be usually performed for 6-8 weeks to show considerable improvement in the position of the deformed foot.
  • Achilles tenotomy – After the manipulation and casting procedure is over most babies require a minor surgery to release the tightness in the heel cord (also known as the Achilles tendon). In this tenotomy procedure the doctor uses a thin instrument to cut the tendon through a minute incision. The tendon heals naturally within around 3 weeks and the doctor will put the baby’s foot in a cast to promote faster healing through stabilization of the foot and ankle. The cast will be removed once the Achilles tendon has re-grown to proper and longer length and the previously deformed foot is now in a normal position.
  • Bracing – There is a chance that the clubfoot in the baby might recur even after correction using manipulation and casting. The doctor will suggest putting the baby’s feet in a brace called ‘boots and bar’ for a few years to ensure that the feet remain in the corrected position.

French method

The French method is another type of non-surgical method for correcting clubfoot and is also known as the ‘physical therapy’ or ‘functional’ method. It involves stretching, mobilization and taping. This procedure is performed by a physical therapist with specialized training and experience.

The French method needs to be initiated soon after birth to be more successful and requires the participation of the family as well. The physical therapist will perform stretching and manipulation to the deformed foot and then tape it in a stretched position. A plastic splint is put over the tape to retain the improved motion range.

This method shows significant improvement in the baby’s foot position within the first three months and might require an Achilles tenotomy to maintain the restored mobility of the foot.

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What are the surgical treatment options for Pediatric Clubfoot?

Most cases of congenital clubfoot can be treated with non-surgical (Ponseti and French) methods if started soon after the baby’s birth certain severe cases of clubfoot require a surgical approach as the deformity can recur or the severity makes the non-surgical methods unsuccessful.

The surgical methods are required to adjust the joints, ligaments and tendons in the foot and ankle to correct severely deformed foot caused by the clubfoot disorder in a child.

There are two main types of surgical methods that is required, such as:

Less extensive surgery

This surgery will aim to release only those tendons and joints that are causing the deformity. Mostly this will require releasing the Achilles tendon behind the ankle or a ‘tendon transfer’ which involves shifting the tendon which is situated at the front of the ankle to the inner side of the mid-foot. This ‘tendon transfer’ procedure is also called an anterior tibial tendon transfer.

Reconstructive surgery

A major reconstructive surgery for clubfoot requires extensive release of a number of soft tissue structures of the foot. Once the desired correction is achieved the joints in the foot are stabilized with the help of pins and a leg cast (from toes to thigh) will be put on the operated leg to help promote the healing of the soft tissue.

The doctors will usually remove the leg cast and the pins after about 4-6 weeks and put a short-leg cast for the next 4 weeks. In order to avoid recurring of clubfoot the doctor will advise to put special brace or shoes for at least a year after the surgery.

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