After the clubfoot is completely corrected, the foot may recur during the period when the child is wearing a brace. In general, the younger the child, the higher the likelihood of recurrence; recurrence after age 6 is rare in children with no other defects than clubfoot. Early detection and early correction of recurrences is important to continue to obtain good results.
1. Causes of recurrence
The pathological factors that lead to congenital clubfoot are also the main source of recurrence. As mentioned earlier, the cause of clubfoot may have an active period of up to several years.
2. Causes of recurrence
a Failure to wear a brace
Failure to wear the brace correctly: more than 80% of recurrences.
Correct bracing: only a minority of recurrence cases.
b Treatment failure
1. Adequate abduction was not achieved, that is, the displacement of the navicular bone was not completely corrected.
2. Adequate dorsiflexion was not achieved.
cMaybe in a few cases, there is too severe fibrosis in the muscles, fascia, ligaments, and tendons on the medial and posterior sides of the foot?
dOther defects associated with clubfoot.
Congenital polyarticular curvature, spinal cord herniation. or other neurological defects may have a strong influence as an additional factor causing recurrence.
3. Prevention of recurrence
a Give the correction of the “70° over-adduction” in the youngest children.
b Strict use of the brace, following the protocol for its use.
cStretching the gastrocnemius muscle.
Recommendation: 2 minutes of pulling before the parent puts on the brace.
d Squatting with the foot on the ground: pulling on the posterior tibial muscles.
Suggestion: Parents should have the child squat for 2 minutes each day.
ePhysical therapy
To promote active movement of the foot and to help coordinate the foot with the physiological movement patterns of the whole body, neurophysiological treatments and techniques can be used.