What is clubfoot?

 

Clubfoot is a congenital misalignment of the foot. “Inborn” means that the condition is already present at birth. The complex malposition with the feet turned inwards contains various individual components, the knowledge of which is relevant for the therapy.

 

Most children who are born with club feet have no other congenital problems. However, club feet can be associated with other abnormalities,

 

Without medical treatment, spontaneous improvement is not expected in clubfoot. Since there are good treatment options, clubfoot does not have to be accepted as fate.

 

 

What are possible causes of club feet?

 

There are various factors (position in the womb, amount of amniotic fluid, neurological causes, genetic causes) that can promote the development of club feet. The actual mechanism of origin is still unknown. There are also families in which club feet are common. In these cases, a genetic cause can be assumed.

 

At a certain point before birth, parts of the foot bones and muscles stop growing, so that the shape of the foot changes towards the club foot. This form is probably also favored by the position of the baby in the mother's belly. The majority of children who are born with club feet show no other abnormalities. Nevertheless, it is important to recognize or rule out any additional abnormalities early after birth.

 

 

Basic principles of clubfoot treatment

 

The goal of the treatment is

• to bring the foot into a normal position (reduction phase) and

• to maintain the correction achieved (retention phase)

 

 

When is the best time to start therapy?

 

Treatment does not have to be started immediately after birth. Ideally, gypsum therapy should be started within 7-14 days after birth. If early treatment is missed, therapy can still be started at a later time.

 

 

How are club feet treated?

 

Club feet are usually treated conservatively, ie without surgery.

The first part of the treatment is the so-called plaster reduction therapy. The feet are gently manipulated every week and brought step by step towards normal position. Weekly plaster changes are necessary for this.

The international gold standard in clubfoot treatment is the Ponseti method. The correction of the malposition is achieved through manipulation and weekly new plastering. Most cases of congenital clubfoot in young children can be corrected with this procedure within 5-7 weeks. In about 80% of the cases, a small outpatient procedure is necessary after the redressive treatment to lengthen the Achilles tendon. A plaster of Paris is then put on for a further 3 weeks in order to bring the Achilles tendon into a corrected position for healing.

 

Since the clubfoot can reappear after the correction in the course of further growth, this must be prevented by the so-called retention therapy. So-called foot abduction splints are usually used for this. These are used for both one-sided and double-sided clubfoot. The rails consist of shoes which are attached to an adjustable rail by a mechanism. This keeps the feet in an optimal position. Initially, the splints are worn for 23 hours a day in the first 3 months. During this time, the splints should only be removed for personal hygiene. After that, the splint should only be worn at night until you are 4 years old. The majority of children tolerate this approach very well. Carrying the splint does not hinder the child's development in terms of sitting, crawling, and running.