Clubfoot is a congenital deformity that affects one in every 1,000 births in the US. Causes include limited space in the uterus and abnormal positioning of the feet. Treatment options include plaster casting, non-surgical methods such as the Ponseti and French methods, and surgery. Recurrence is possible, but with careful monitoring, children can lead normal lives.
Clubfoot is a congenital deformity that develops in the uterus during the first trimester (between 8 and 12 weeks) and causes abnormal twisting of the ankles, heels, toes, and feet. Thales occurs in one of every 1,000 deliveries in the United States (US), and 95 percent of these incidences are known as clubfoot (CTEV) or clubfoot. This type causes the foot to bend inward with the toes pointing down.
Causes. Causes of clubfoot include abnormal position of the feet and limited space in the uterus during fetal development, which can cause malformed tendons, muscles, and bones. Also, a lack of amniotic fluid in the sac surrounding the fetus, or oligohydramnios, can increase pressure on the feet, even leading to clubfoot.
While there is no conclusive evidence that clubfoot is hereditary, statistics indicate that there is a three to four percent chance that a child will develop it if one parent has this deformity. This percentage increases to 15% if both parents are affected. For normal parents who have a child with this problem, there is a 10 to 10 percent chance that their next child will have clubfoot. Furthermore, boys are twice as likely to have the condition as girls.
Treatment. Treatment for clubfoot should begin soon after birth. The goal is to return the feet to their normal position to allow for proper function and to eliminate pain and deformity. The treatments available are:
1. Plaster casting and serial splinting
This weekly clubfoot treatment consists of gentle manipulations to move the feet as far as possible towards the correct position and to maintain this correction with a plaster cast. The splints are then used as a follow-up treatment. These are flexible, as they can be used at various times during treatment and can be worn 24 hours a day or only at night. Shoes used with splints should be straight lace-up shoes with a straight medial edge.
2. Non-surgical methods
There are two well-known non-surgical methods of treating clubfoot:
a) The Ponseti method
Developed by Dr. Ignacio Ponseti of Iowa, the Ponseti Method begins with a series of gentle manipulations and placements of the cast from toe to thigh for the first five to seven weeks. The heel cord is cut to complete the foot correction before the final cast is applied. Then, the last cast is placed for three weeks, by which time the heel cord has healed properly.
After this, a special splint called the Denis-Browne splint is put in place. This splint consists of two high, open-toed shoes connected by a bar, which is adjusted according to the correct position of the feet. The splint is worn full time for two to three months and then only at night for the next two to four years.
b) The French method
This treatment requires daily one-hour therapy with a qualified physiotherapist. It consists of a slight stretch of the feet, followed by taping to keep them in the best position. At night, the taped feet are connected to a machine that allows for continuous passive motion to maximize stretching. For two hours a day, the tape is removed to air the skin. Physical therapy sessions continue daily for up to three months, and recording is stopped once the child starts walking.3. Surgery
Posteromedial release surgery aims to loosen and stretch tight ligaments and tendons in the medial and posterior parts of the feet. To maintain proper position after surgery, the feet are fused every two weeks for six weeks and then splinted or braced for another six weeks. Surgeons usually wait until the child is one year old, but some begin operating when it is clear that nonsurgical methods are failing to correct the clubfoot.
The risk of clubfoot recurrence is as high as 25 percent until the child reaches one year old. However, constant monitoring and careful observation are required during childhood and adolescence. Without any recurrence, children with talipe will continue to lead normal, active lives.
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