February 24, 2011

Clubfoot: Treatments - Part II

clubfeet in castsLast week we discussed what causes clubfoot.  Depending upon what caused the clubfoot and the severity of the clubfoot, there are different levels and types of treatment.  For example, if a child has clubfoot because of the child’s position in the womb, then the foot may be adjusted through physical therapy. Nearly all children with clubfoot are treated with serial castings and braces.  Those who have other complications, such as spina bifida, may need surgery.  Yet, one study showed even children with other medical issues may be able to be also treated through castings and braces, [reference 1] although some studies show that they probably need more intensive treatment. [2]

Treatment usually begins at 1 week old to 2-and-a-half years old.[2]  Most children are treated with the Ponseti method, which involves serial castings.  These are casts that are put on every week to few weeks; each time the castings go on, they slowly change the position of the foot. [1]  For example, a child may have 6 castings done between one and 3 months old.  Of course, if your child is in China, he may not be receiving such treatment.

Once the series of castings are done , the child will usually wear a foot adjunction brace to keep the foot in proper position -- much as people wear retainers after having braces on their teeth.  Like a retainer, these shoe braces are initially worn nearly all the time and then just at night.

At this time about 90% of all children with clubfoot will have a type of surgery often called a tenotomy of the Achilles tendon to correct hindfoot varus.[1] For children under one, this can be done with a local anesthesia in the doctor’s office.  For children over one year old, the surgery is usually performed with sedation in the operating room.[1]

Once the the tenotomy is performed, another cast is applied, and usually the foot heals in about 3 weeks.  After this last cast, the child then goes into a foot abduction brace.  These braces have shoes attached to a bar.  Usually the child will wear the brace for 23 hours per day for 3 months; then while sleeping (12-14 hours/day) until the child is 4 years old.  It is during this time that children and parents are not always compliant, and the child’s clubfoot can relapse.  Sometimes the clubfoot can relapse even when the child wears the brace as instructed.  If this happens and it is caught early, then the child usually wears a cast again and then the brace. [1]

If a child is 3 or older and has what is called hindfoot varus with dynamic supination of the forefoot while walking, then that child will have a surgery called tibialis anterior tendon transfer to the third cuneiform.  After the surgery the child wears a cast for 6 weeks.  In this situation no brace is required after the casting.  The child then receives physical therapy to help with walking and strength building.[1]

The treatment may seem rigorous, and dedication is required, but the children can do very well once treated.

For more information and some great pictures go to the American Academy of Orthopaedic Surgeons.

Shriners Hospitals at the following cities/ locations provide services in orthopedics for children  at no cost. If your child has clubfoot, you may be able to have our child treated at one of these sites.

  • Chicago
  • Los Angeles
  • Spokane , WA
  • Erie , PA
  • Northern California
  • Springfield, MA
  • Greenville, SC
  • Philadelphia
  • St. Louis
  • Honolulu
  • Portland
  • Tampa
  • Houston
  • Salt Lake City
  • Twin Cities
  • Lexington, KY
  • Shreveport

[1] Dobbs, M.  B., & Gurnett, C.  A.  (2009, February 18).  Update on clubfoot: Etiology and treatment.  Clinical Orhtopaedics and Related Research, 467, 1146-1153
[2] Gurnett, C. A., Boehm, S., Connolly, A., Reimschisel, T., & Dobbs, M. (2008, July). Impact of congenital talipes equinovarus etiology on treatment outcomes. Developmental Medicine and Child Neurology, 50(7), 498-502

0 comments on “Clubfoot: Treatments - Part II”

  1. Our beautiful daughter, Lizzie, came home at the age of 2 from China with an unrepaired clubfoot. She was walking and running and climbing on her foot that was completely backwards and upside down. She had a tough case and it took a total of 18 casts, for a total of 21 weeks in a cast. However, it was all so worth it. Now, her foot looks great and is such a great soccer player that I sometimes have to get my hubby the coach to pull her off the field so that the other kiddos stand a chance! LOL! She can run faster than most and is still climbing everything!!! You would never know that her foot was ever anything than what it is now! The castings were relatively easy, she just had so many but I do think her foot was one tough case. Ultimately the Lord brought us through and I cannot imagine our lives without her. I would not hesitate to adopt another precious child with clubfeet!

    1. Annie,

      Thank you for sharing this with us, and trust others will be inspired by your daughter's progress. I also have a Lizzie who plays soccer and a husband who coaches a girls' soccer team.

      Your daughter's victories demonstrate what good medical care, a tenacious mom, and God's hand can do in a child. Seems that Lizzy has quite a bit of spunk as well.

  2. Clubfoot: Pre-Adoption Assessment of a Child Referral–Part III | From Hope to Reality | The Adoption Blog of Nightlight Christian Adoptions says:

    [...] the past two blog posts, we discussed what clubfoot is, the types, and the treatments. Certainly what causes clubfoot may impact the type of treatment your child will receive.  So how [...]

  3. We are considering adopting a little girl with club feet and post-operative meningocele. She is almost two yrs old and is walking, although from the pics it doesn't look like the club foot surgery was very successful- particularly with one foot.
    What are the chances that this will be able to be repaired and will she always have difficulties due to the meningocele? It will take us almost a year to go get her and so she will be walking around on the side of her foot that whole time...will this make it more difficult to repair?
    Thanks for any advice any of you may have.

    1. Dear Anna,

      So pleased that you were able to gain some information on meningocele and club foot from these blog posts. The types of treatment that this toddler will received while in her country awaiting adoption is uncertain, so it would be wise to ask the agency staff if they know what exact treatment she has received and what she will continue to receive. Is she in a foster home or an orphanage? Where she is residing and the facilities in the area can also influence the level of treatment she may receive. That being said, you seem to indicate that she will not receive any further treatment until she is adopted. Based on this worst-case-scenario, I suggest that you ask a medical professional who specializes in treating clubfoot if her condition will worsen if she receives no treatment. Also, the health care provider will want to know more about the meningocele (location, treatment), as this could affect her clubfoot.

      Nightlight provides an extensive list (it is on the website) of health care providers and clinics that specialize in evaluation of internationally adopted children https://nightlight.org/downloads/Medical%20and%20Counseling%20Resources.pdf . This resource has a link to the Shriners Hospital,l and many of these hospitals treat children with orthopedic issues, including clubfoot, at no charge beyond what your insurance pays. Families have been very pleased with their services and the staff's sensitivity to the emotional needs of adopted children.

      I regularly tell families that it is easy to focus in on the health needs of a child; however, the issues that you will be dealing with on day-to-day basis, sometimes long after the child's medical issues are resolved, are the child's emotional issues.

      I wish you well. Laura

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