Magazine article The Exceptional Parent

Clubfoot: An Orthopaedic Surgeon Describes Clubfoot and Current Treatment Methods

Magazine article The Exceptional Parent

Clubfoot: An Orthopaedic Surgeon Describes Clubfoot and Current Treatment Methods

Article excerpt

As an orthopaedic surgeon who has treated numerous cases of clubfoot in my career, I know that it takes exceptional parents to deal with the challenges of a child born with a clubfoot. However, it should be noted that a clubfoot diagnosis does not mean a life of pain, deformity, and disability for your child. Today's treatment options hold out much hope and promise. But what is clubfoot and what treatment methods are most effective?

What Is Clubfoot And How Common Is It?

Clubfoot, which occurs in about one in a thousand births, is the most common musculoskeletal birth defect and is the seventh most common birth defect overall. By a 2 to 1 ratio, boys are more affected than girls. Additionally, about 50 percent of cases are bilateral, affecting both feet.

Most children born with a clubfoot have no other associated medical problems. Still, clubfoot may be part of other disorders such as myelomeningocele (a spinal cord development problem which results in weakness or paralysis of the lower extremities) or arthrogryposis (being born with stiffness and contracture of multiple joints).

There has been extensive research devoted to studying clubfoot, yet the scientific origin remains unknown. The genetic basis of clubfoot is slowly being unraveled, and there is clearly a hereditary aspect to clubfoot.

With modern, hi-tech ultrasound during pregnancy, clubfoot is often detected while the baby is still in the uterus, often by the second semester. The joys of pregnancy and anticipated motherhood can quickly deteriorate into distress and concern: "Will my child have limited mobility and not be able to walk or run properly? Will my child be the object of strangers' stares? Will my child be denied job opportunities or relationships because of the clubfoot condition?" With the practice of abortion accepted among many in today's society, the question of whether to terminate the pregnancy becomes a real issue with some expectant parents.

The good news is that, using modern treatment techniques, most children with a clubfoot do wonderfully. Recent studies indicate that more than 95 percent of children treated with the "Ponseti technique" have an excellent outcome and the large majority are still functioning normally after 35 years.

Parents often play an important role in accomplishing this outcome as they make concerted efforts toward inculcating a positive attitude and building self-confidence within their child. Parents can also assertively nurture their child's physical circumstances with regular, ongoing intervention and advocacy.

Clubfoot is a deformity of the lower limb, characterized by adductus of the forefoot, cavus (increased longitudinal arch), varus of the heel (heel is turned in), and equinus of the foot (foot is in plantar flexion) as well as a small calf muscle. Although the most severe deformity occurs in the hind foot, all components of the deformity are interrelated.

Pathologically, the ligaments of the posterior aspect of the ankle and the medial and plantar aspects of the foot are shortened and thickened. The muscles and tendons of the gastronomies tibialis posterior and toe flexors are shortened and smaller in size.

Physicians do not know the causes of clubfoot and so cannot prevent the condition. Instead, we treat the results of clubfoot. The goal of treatment is to correct all components of the deformity so that the patient has a pain-free, callus-free foot with good mobility and no need to wear modified shoes and inserts.

The Ponseti method

The Ponseti method, developed by Dr. Ignacio V. Ponseti from the University of Iowa, has become the gold standard for treating clubfoot. It is based on specific manipulations and casting and does not require any significant surgery. The Ponseti method has dramatically improved the results of treatment of children born with this condition. Today's Internet savvy parents account, in large part, for the growing use of the Ponseti method in recent years. …

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