Last 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. 
Treatment usually begins at 1 week old to 2-and-a-half years old. 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.  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. 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.
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. 
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.
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.
- Los Angeles
- Spokane , WA
- Erie , PA
- Northern California
- Springfield, MA
- Greenville, SC
- St. Louis
- Salt Lake City
- Twin Cities
- Lexington, KY
 Dobbs, M. B., & Gurnett, C. A. (2009, February 18). Update on clubfoot: Etiology and treatment. Clinical Orhtopaedics and Related Research, 467, 1146-1153
 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