Congenital clubfoot must be treated early

  As a result, we have encountered two cases of congenital clubfoot that were delayed because the parents listened to others (including primary care doctors) that the child would be treated when he was older, so we feel that our training is not enough and the popularization of science is not enough.  Congenital clubfoot is a common birth deformity, the incidence is 1 per 1,000 newborns in China, more boys than girls, can be unipedal, but also bipedal involvement. There are many causes of congenital clubfoot, which are still inconclusive in the world and may be related to genetics, environment, fetal position in the womb and other factors.  The child is born with a foot deformity, with varying degrees of foot droop, resembling a horseshoe, inward pointing of the toe, inward turning of the heart of the foot, medial soft tissue contracture, and in severe cases, a “crab claw-like” deformity. Due to the typical presentation, the diagnosis is not difficult.  The traditional treatment for clubfoot is to wait until the child is 6 months old and then perform orthopedic surgery to release the contracted soft tissues and then fix the foot in a normal position with steel pins and a cast. As a large number of tendons and ligaments are loosened and severed, the normal anatomical structure of the foot is destroyed, leading to later recurrence, small foot development, talar head necrosis, walking pain and other complications and sequelae, so that the quality of life of the child in the future is significantly reduced.  1, the concept of congenital clubfoot: the child is born with foot deformity, foot drooping to varying degrees, the heel resembles a horseshoe, the tip of the foot inside the finger, the heart of the foot inversion, medial soft tissue contracture, serious cases can be “crab-like” deformity. Due to the typical presentation, the diagnosis is not difficult. According to the cause and severity of the disease, can be divided into a variety of types.  2, the etiology of congenital clubfoot: congenital clubfoot caused by many causes, the world is still inconclusive, may be related to genetics, environment, fetal position in the womb and other factors. Congenital clubfoot occurs in more boys than girls, the incidence of 1 per 1,000 newborns in China, can be unipedal, but also bipedal involvement.  3, how to treat: the general principle is that the younger the age of consultation, the better the effect. Depending on the age of different types of different treatment options. The general situation according to the age of consultation, divided into six months before the conservative treatment and six months after the surgical treatment.  The best and most advanced treatment for congenital clubfoot is the early treatment method. (Ponseti method).  4, what is the early treatment of congenital clubfoot: that is, 5 days after the birth of the child, a professional pediatric orthopedic surgeon to give manipulation and cast orthopedic. The cast is changed once a week, and depending on the correction of the deformity, the cast is fixed 5 to 10 times to gradually correct the inversion, inversion and partial horseshoe deformity of the foot. Finally, it is enough to give a brace fixation.  5.What to do if you miss the early early treatment time: there can be remedies! Different treatment methods are available for children of different ages: for example, late plaster orthopedics, soft tissue release after 6 months, complete release of the subtalar joint; tendon orthopedics at older ages, diaphyseal fixation; triple joint fixation after 10 years of age, foot and ankle brace orthopedics, etc. Through these procedures, the deformity can be corrected, but the surgery is traumatic and expensive. In the long run, early and early treatment does not destroy the normal structure of the child’s foot and causes less damage, so the results are better.  The best and most advanced method of treating early congenital clubfoot is the Ponseti method (Ponseti treatment), which is an early continuous plaster orthosis with percutaneous Achilles tendotomy and orthopedic brace treatment.  Treatment is started 5 days after birth, with manipulation and casting by a specialized pediatric orthopedic surgeon. The cast is changed once a week, and depending on the deformity correction, the cast is fixed 5-10 times to gradually correct the inversion, pronation and partial horseshoe deformity of the foot. Then, a minor surgery of percutaneous Achilles tendon severing is performed to completely correct the horseshoe deformity, and finally an orthopedic brace is given for 2-3 years to consolidate the effect and prevent recurrence.  The advantages of the Ponseti method are: (1) The normal anatomical relationship between the bones of the foot is gradually restored by means of manipulation and plaster, and the muscles and ligaments of the foot are completely preserved, thus preserving the developmental capacity and stability of the foot.  (2)The plaster operation is painless, the surgical operation is minimally invasive, the brace is easy and comfortable to wear, and the child can easily tolerate it.  (3) Good efficacy, high success rate of treatment, low recurrence rate, no small feet, walking pain and other long-term complications.  (4) The child is spared the pain of major surgery, and the parents spend less and can easily accept it.