Clubfoot, a congenital birth defect where one or both feet point downward and inward, affects 1.2 in 1,000 children, reports the University of Missouri Health System. In around 50 percent of cases, clubfoot affects both feet. Clubfoot affects boys twice as often as girls, according to Weill Medical College of Cornell University. Family history, positioning of the fetus before birth and low fluid levels in the uterus can all cause clubfoot. Treating clubfoot takes months of therapy to slowly turn the foot so that it's functional. Treatment optimally begins shortly after birth.
Stretching and Casting
Treatment starts right after diagnosis with gentle stretching of the foot by a physician to loosen the abnormally turned muscles and tendons. Casting applied right after stretching holds the foot in a slightly more normal position. Stretching and casting, called the Ponseti method, is done weekly for the first month to six weeks of life and continually moves the foot toward a more normal position. Stretching and casting continues every two weeks until the foot is in a normal position, Weill Medical College explains. Caretakers continue stretching the foot several times a day when casting and other treatments are complete, to keep the foot flexed in the proper position.
Tenotomy
Around 90 percent of children with clubfoot require minor surgery to release the tight heel tendon. Called a tenotomy, this is done in an office procedure under local anesthetic, the University of Missouri Health System reports. Cutting the tendon, called tenotomy, loosens the foot and makes it easier to stretch. Tenotomy is done right before the last casting.
Surgery
Around 66 percent of children with clubfoot require surgery in addition to stretching and casting, according to Weill Medical College. Surgery is performed between 6 weeks and a year of age. Pins placed into the bones hold them in place so they can heal properly and a long leg cast which extends up to the thigh maintains the proper position. Even after surgery, the foot will be slightly smaller and less functional than normal and the calf muscles in the lower leg will be less developed, notes the American Academy of Orthopaedic Surgeons.
Bracing
Once casting and/or surgery is complete, the child wears a splint of brace called a Dennis-Brown splint 23 hours a day for several months, then during naps and at night for two to three years thereafter, the University of Missouri explains. The brace consists of a metal bar with shoes attaches that are specially fitted to the child. Application of the brace is essential for maintaining the foot in proper alignment of the muscles will pull the foot out of alignment, the American Academy of Orthopaedic Surgeons warns.
