Idiopathic clubfoot treatment care and rehabilitation strategy

  The incidence of idiopathic clubfoot is about 1 in 1,000, and early diagnosis and treatment are crucial to its prognosis. Early detection and standardized treatment can lead to a good prognosis for more than 90% of children. Currently, ponseti technique is recommended for the standard treatment of clubfoot (recommended to be seen in specialized pediatric orthopedic clinics). From birth to 4 weeks, ponseti manipulation is the main treatment.  After full term, continuous external plaster fixation can be performed, depending on the degree of deformity of the child, for 4-8 weeks, with weekly cast changes. At this stage, continuous orthopedic cast fixation and intensive care of the cast are maintained.  After continuous external fixation, the child usually needs further surgery for Achilles tendon lengthening, mainly percutaneous Achilles tendon lengthening for children within 2 weeks of age, which is less invasive and requires no wound dressing change.  After removal of the cast, a custom-made ponseti brace is required to maintain the orthosis, which is usually worn all day for six months and then replaced with a nighttime brace for six months (no standing weight-bearing for the child), during which ponseti massage is required daily. Regular outpatient review every three months.  After the above treatment, a small number of children still have inversion deformity, mainly due to the imbalance in the development of the medial and lateral muscles around the ankle, which may require an external tibialis muscle transfer after the primary care physician’s assessment, usually after the child is 2 years old. After surgery, the cast is re-fixed for 6 weeks and the ponseti brace is removed to maintain the orthosis for a period of time depending on muscle strength recovery.  After external fixation of the cast, it is necessary to strengthen the care of the cast to avoid cast breakage and boot removal, which may aggravate the deformity and cause other complications. Closely observe the learning movement and activity of the affected limb.