Congenital Abnormalities

Congenital Abnormalities

Clubfoot is a birth defect and one of the most common and oldest known diseases to man. It shows itself from the very moment of birth. In this foot deformity, forefoot rotates inward and downward. Hind foot (heel) also rotates inward.
In clubfoot condition, tendons that connect the leg muscles to the anklebones become shorter and tighter, which causes the ankle to rotate inward. Although clubfoot is diagnosable at birth, most cases are first diagnosed during pregnancy ultrasound. In almost half of children suffering from clubfoot, both feet are involved. In addition, boys are twice as likely to develop this disorder as girls are.
Causes of Clubfoot
Researchers are still not sure about the causes of clubfoot. The most plausible theory is that the clubfoot incidence is the result of a combination of environmental and genetic factors. Newborns are more likely to develop the disease in families with a background of the disease.
Clubfoot Treatment Methods
By treatment, here we mean to relieve the pain in the foot and restore the normal function of the foot so that the patient’s feet soles can completely touch the ground while walking and standing. Clubfoot, with any severity of any kind, cannot be cured without treatment.
Non-Surgical Treatment
No matter how severe the clubfoot is, surgery is not used in its initial methods of treatment.
Ponseti method
It is the most widely used technique in North America and around the world, using gentle stretching and orthopedic cast to correct this condition gradually. The best time to use this method is a little while after birth of the child, although older infants have also been treated successfully. Ponseti method principles are:
Manipulation and plastering (H4)
In this method, the child’s foot are stretched gently and manipulated in a way to get it right. Then, from the toes to the leg are casted so that the leg be stable in its right position. The procedure that involves stretching, correcting, and casting, is repeated each week until a significant improvement in foot condition is achieved. In most cases, the practitioners achieve improvement in about 6 to 8 weeks.
Tenotomy
After manipulation and casting period, most of the children need to undergo a minor surgery to release the Achilles tendon (heel-cord) tendon from permanent tightness and shortness.
In this short-time surgery (known as a tenotomy), the doctor uses a very thin tool to cut the tendon. The cut is very small and does not require stitches. The foot is casted again so that to be protected at the time of tendon recovery, which usually takes about 3 weeks. By the time the cast is opened, the Achilles tendon has re-grown to a longer and more appropriate size, thus the clubfoot is completely treated.
French method
It is another non-surgical treatment method of clubfoot including stretching, animating and strapping. The French method (also called functional method or physical therapy) is generally performed by an experienced and trained physical therapist.
Like ponseti method, using French method can begin shortly after birth and requires family members’ involvement. The child's foot must be stretched and manipulated daily, and sealed with a special adhesive tape to maintain the improvement in the range of motion obtained by manipulation. After strapping, a plastic splint is put on the adhesive tape to maintain the improvement in range of motion.
Using this method, you should visit a physician almost three times a week. Because this method should be performed daily, the doctor will teach parents the correct ways of doing it at home.
Most newborns' foot conditions improve dramatically after 3 months, making the need for specialist visits less frequent. Infants under treatment by this method, like infants treated with ponseti method, usually require the release of the Achilles tendon to improve their ability to bend the ankle backward.
To prevent clubfoot recurrence, the family should continue daily stretching, strapping, and splinting until the child is 2 to 3 years old. So one of the non-surgical methods of clubfoot involves stretching, animating and strapping.
Using foot braces
Usually, the clubfoot disorder reoccurs even after successful correction by using cast. To ensure that the foot maintains its corrected condition forever, the child should wear foot braces for some years. The brace keeps the ankle at the right angle to maintain the correct position.
Although using brace can be overwhelming for parents and families, it is essential to prevent the recurrence of the disorder. In the first three months, the child should wear the brace almost all the time (i.e. 24 hours a day). The doctor will gradually limit the time needed to wear a brace to only nights and sleeping periods (approximately 12 to 14 hours per day). Most children continue wearing braces for 3 to 4 years.
Braces have different types and they are all made of shoes, sandals or custom footwears attached to the two ends of a metal strap. This strap can be stable. In this case, the legs move together, or it can be movable, letting each leg to move separately. The doctor will explain to parents what kind of braces their baby needs.
Usually, infants get restless in the first few days of use, but get used to it over time.
Surgery
Although many clubfoot cases are successfully treated using non-surgical methods, sometimes this deformity cannot be fully treated using those methods. Likely, some other time the condition of clubfoot gets worse due to the parents’ inability to follow treatment plan.
In addition, this deformity in some children is so severe that it cannot be treated by stretching. In such cases, surgery is needed to correct the tendons, ligaments and joints

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