What is congenital clubfoot?
Congenital clubfoot is a developmental deformity that can be detected at birth. Clubfoot can occur in one or both feet.
During pregnancy, a normally developing foot transforms into a clubfoot, which is characterized by thick and tight medial tendons and ligaments and shorter than normal muscle development. As a result of this transformation, the posterior and medial portions of the foot are pulled together, causing the foot to twist downward and inward. The bones of the foot are thus in an abnormal position. The foot turns over, stiffens, and the child is unable to place the foot in its normal position in the usual way.
When to start the treatment of clubfoot (Pansetti method)?
Within a short time of birth (~7-10 days): Best
For children who are not yet walking: Very effective
Walking children up to teenage years: Effective, correcting all or most of the deformity.
Older children may require additional surgery, depending on the severity of the condition and whether there are health problems associated with it.
Treatment of clubfoot at a glance
The following is a general procedure for the treatment of congenital clubfoot in small infants and children. If your child is older or has other health problems in addition to clubfoot, the treatment plan will be different.
1. Manipulation and cast orthosis
After a few weeks of manipulation, the bones are reset to their normal position so that the foot deformity is gradually corrected.
After each manipulation, the foot and leg are put in a cast and kept for 5-7 days to keep the foot in position and to allow the tight ligaments, joint capsule and tendons to stretch and elongate.
This procedure is done approximately 4-6 times. Severe horseshoe foot should be put into a cast several more times.
2.Manipulation, Achilles tendon amputation and plaster orthosis
In most cases, the Achilles tendon will be severed to complete the orthosis. The procedure is performed under local anesthesia and takes only a few minutes. The Achilles tendon will repair itself and the foot will be dorsiflexed enough by the Achilles tendon severance.
The foot and leg are again put in a cast and kept for 3 weeks.
3. Use of a brace to maintain orthosis
After the last cast is removed, the child’s foot will be placed in a brace. The brace is worn continuously for 3 months, 23 hours a day. It can only be removed during bathing.
After 3 months, after a period of time, the brace is worn for a shorter period of time. Finally, the child will only need to wear the brace at night (12-14 hours per day) until the age of 4-5 years.
The brace is a key part of the treatment. Even though your child’s foot looks normal, there is a risk of a recurrence if your child does not wear a brace. By the time your child reaches 7 years of age, recurrences are rare.
4. Physical therapy
Different therapies help maintain the correction and support your child’s development.
Parents give the child traction and other treatments in person as directed by the doctor or therapist.
To achieve the best treatment results, follow the instructions strictly.
Guidance and helpful suggestions for the cast placement phase
Each time you come to change the cast, bring something for your child to eat or drink, such as a bottle, a favorite toy or a book to distract them during the cast.
1. After the first cast
Your child may feel uncomfortable. The cast will be heavy until it is thoroughly dry.
Roll a small towel and place it under the knee until the cast is dry.
Play with your child, sing, feed him, or do something he likes to distract him.
After about a few hours, your child will get used to the cast.
As soon as the cast is dry, your child can be allowed to do whatever he normally likes to do. Don’t worry about the cast breaking or getting dirty, it is very strong. In wet weather, make sure the cast has completely dried and hardened before allowing him to crawl.
When your child is sleeping, roll a towel under the knee to relieve pressure on the heel.
2. Throughout the cast-wearing process
Keep the cast dry. Never wash the cast with water, if there are stains, you can wipe them off.
Wear socks over the cast in winter to keep the cast clean or to keep your child’s toes warm.
Cover your child’s bottom with a diaper or diaper so that the cast does not become contaminated.
You should not give your child a tub bath while he or she is wearing a cast.
To keep your child clean.
1. Put your child on a towel with his or her clothes off.
2. Wet your hands and rub soap on them.
3. Rub the child’s body with soap.
4.Wash the soap off the child carefully with a cloth, without getting the plaster wet.
5.Dry the child and put on clothes.
Check your child’s feet often.
Check your child’s feet several times a day to make sure they are the normal color and warm. You can observe the blood circulation by pinching the toes. If the blood circulation is good, the color of the toes will quickly return from white to pink.
Call your doctor if
- The toe does not return to its normal color.
- The toe becomes swollen.
- The toe turns white, blue or purple.
- The skin around the edge of the cast becomes very red, painful, or inflamed.
- The cast is too tight.
- The cast is broken or not as hard.
- The cast gets wet and is not as hard as it should be.
- You smell a foul odor inside the cast.
- You can’t see your toe – notify your doctor immediately.
Guidance and helpful advice during the use phase of the brace
When the child has the last cast removed and the brace is put on, there is a 3-7 day period to get used to it. Children feel uncomfortable not only because they are losing their “secure cast” but also because they cannot kick their legs apart.
Never remove the cast just because your child is crying – your child needs to get used to it!!!
The first few days of tolerance are very important for the long term use of the brace. If you take the brace off in the first few days, the child will learn that crying is a very effective way to avoid the brace and you will have more trouble putting the brace on your child in the future.
You must know that not wearing the brace the right way and at the right time is the most common cause of relapse!
Wearing a brace must be part of your child’s daily life.
1. How to put on the brace
Before putting on the brace, make sure the skin is clean and dry.
Never use skin lotion on red skin as this will make the problem worse.
When putting on the brace, put on the most difficult foot first, gently dorsiflex the foot and put the heel into the brace first. Place the foot in position and close the inner shoe tab first, then attach the other outer tabs. Then put on the other foot.
Make sure the heel is properly placed in the support and check through the viewing holes to confirm that the heel is in the correct position. You should be able to see the heel through the viewing hole in the shoe.
Play with your child and teach him/her to kick both feet together in the brace at the same time to help him/her get used to the brace.
2. Wear the brace all day (23 hours a day) for 3 months
Remove the brace only when bathing, but not for more than 1 hour.
3. Shorten the time of wearing the brace to nighttime wear until 4-5 years old You must have a doctor’s order and guidance before you can change from wearing the brace all day to wearing the brace for a shorter time/night.
Never allow your child to stand in a brace.
Stretching activities can be done under medical supervision.
Walk in soft, flexible shoes.
Don’t forget to have regular checkups, even if everything is going well. You must bring the brace to every review!
Only if your child’s toes are completely out of the brace should they be replaced with a larger size brace.
Do not stop using the brace until your doctor tells you that you can stop using it.
4. Common problems
If your child’s foot slips out of the brace, check that the shoe tabs are tied tightly enough. If you cannot prevent your child’s foot from slipping out of the brace, see your doctor.
If your child shows discomfort or pain very frequently, check for pain or blisters on the heel. If so, see a doctor.
If your child wants to remove the shoe.
a) Put the entire shoe over a sock. This will not always stop him, but it will be much harder for him to take off the shoe.
b) Keep putting the child’s brace on as soon as he takes it off!
If there are any signs of recurrence, see a doctor as soon as possible, don’t wait until the next regular review to see a doctor.
If the brace is broken, call your doctor so that a new one can be custom made.