What kind of deformation is this and how does it happen?
With true congenital clubfoot, the bones of the foot and their relative positions are changed, the Achilles tendon and ligaments along the inner surface are shortened. The foot is lowered down, the sole is turned inward, the forefoot is adducted, and the arch is deepened. The lower leg on the affected side is thinner, the foot is shorter. It is necessary to distinguish from this the positional installation, in which the foot is formed correctly and is easily moved by hand into a normal position, and secondary forms in diseases of the nervous system and muscles, which require a separate examination.
- Idiopathic congenital clubfoot
- Foot positioning
- Secondary forms in diseases of the nervous system
- Syndromic variants in developmental defects
- Unilateral and bilateral deformation
Causes and risk factors
The exact cause of idiopathic clubfoot is unknown. Hereditary predisposition and abnormal foot development in early pregnancy are thought to play a role. The risk is higher if close relatives have such a deformity, as well as with oligohydramnios and close position of the fetus. Boys get sick more often than girls, about twice as often. Clubfoot does not arise due to how the mother carried the child, what she ate or how much she moved, and is not a consequence of errors during childbirth. It is important for parents to know this so as not to look for guilt where there is none.
- Hereditary predisposition
- Disorders of foot formation in the prenatal period
- Male gender
- Oligohydramnios and tight fetal position
- Associated developmental defects
- Diseases of the nervous system in secondary forms
What does it look like and what does it mean without treatment?
The foot is turned inward and downward, it cannot be brought into the correct position passively, the skin folds on the inside and along the back of the heel are deep. The calf muscle on the affected side is underdeveloped, the lower leg looks thinner. Without treatment, the child begins to walk not on the sole, but on the outer edge of the foot and even on the back; Rough calluses and ulcers form on the skin, gait is disrupted, knees, pelvis and spine suffer, and pain occurs. Therefore, treatment begins as early as possible, while the child’s tissues are pliable.
- The foot is turned with the sole inward and downward
- The forefoot is adducted
- Deep folds on the foot
- Gracilis calf muscle
- Walking on the outer edge of the foot without treatment
- Calluses, pain, gait disturbance
- Secondary problems of the knees and spine
Treatment using the Ponseti method
The modern standard is staged plaster casting using the Ponseti method. The orthopedist sequentially, usually once a week, removes the components of the deformity and fixes the foot with a plaster cast from the toes to the upper third of the thigh; In total, an average of five to six dressings are required. For most children, a small intervention is then performed on the Achilles tendon under local anesthesia to bring the foot out of plantar flexion, followed by another cast for three weeks. The method is effective when starting treatment in the first weeks of life, but is also used in older children.
- First casting in the first weeks of life
- Change dressings usually once a week
- On average 5–6 plaster casts
- Subcutaneous achillotomy if necessary
- Final dressing for 3 weeks
- Monitoring the condition of fingers and skin in a cast
- Surgical treatment for severe and recurrent forms
Braces and relapse prevention
After the end of plastering, the most important stage begins - wearing braces, special shoes connected by a bar in the abduction position. At first they are worn almost around the clock for several months, then only during sleep and daytime rest, up to four to five years. It is the violation of the brace regime that is the main reason for the return of the deformity, and not the “weak” casting. A child wearing braces can move, roll over and play. It is important for parents to monitor the condition of their skin, choose the right socks and not take breaks without consulting a doctor.
- Braces immediately after the last cast is removed
- The first months - almost round-the-clock wearing
- Then only during sleep up to 4–5 years
- Strict adherence to the regimen prevents relapse
- Monitoring the condition of the skin and fingers
- Regular examinations by an orthopedist until the end of growth
- Normal physical activity and sports are allowed