1.What is clubfoot? Clubfoot is the most common osteoarticular deformity in newborns. The incidence is about 1/1000 births. The cause of clubfoot is not yet known, but it is highly suspected to be genetically related. Therefore, parents should not blame themselves when their baby is found to have clubfoot. When clubfoot is present in the first birth, it is 30 times more common in the second birth than in normal newborns. If the child does not suffer from other disorders besides clubfoot, after regular treatment by specialized doctors, the child can have the appearance and function of a normal foot, which will not lead to disability or affect the sports and life in the future. 2. Ponseti cast Orthopedic treatment Beginning of treatment The shortened and tense ligaments of the medial, dorsal and plantar sides of the foot are gently pulled for 1 minute every week, and then a long leg cast (from the groin to the toes) is used to fix the foot in the corrected position obtained through pulling. With repeated pulling and cast immobilization, the displaced bones and joints are gradually returned to their normal position. Treatment should start within 1 or 2 weeks after birth because the child’s tissues are more elastic at this time, which facilitates orthotics. Replacement of the cast every 5-7 days Soft casts: the child can be bathed and cleaned after removing the cast itself 2-3 hours before the next appointment to change the cast When to finish the treatment Usually 4-7 casts are needed, and after the last cast is completed, a minor surgery for the release of the Achilles tendon is done, and then the last cast is applied. This cast needs to be maintained for 3 weeks and the cast is removed after 3 weeks. After the cast is removed, the foot may not yet look like a normal foot, but it will gradually return to its normal appearance over the next few years. 3. Bracing – Maintaining the foot in the corrected position Horseshoe inversion foot has a tendency to recur after orthopaedic treatment, so bracing is required to maintain the foot in the corrected position after the last cast is removed. The abduction brace for clubfoot consists of a shoe and an adjustable bar on the sole of the shoe. The distance between the heels of the feet is the same width as the child’s shoulders. In children with unilateral clubfoot, the affected foot needs to be maintained in a 70-degree externally rotated position, while the normal foot can be stabilized in a 45-degree externally rotated position. The brace should be worn at least 23 hours a day for the first 3 months and then at night and during naps for 4-5 years. During the first two nights of wearing the brace, the child may cry and be uncomfortable because the feet are immobilized together. It is very important that the brace is not removed because the child cries, except in cases of skin abrasion or pain due to improper fit. The recurrence rate of clubfoot can be very high if the brace is not worn as prescribed. After the first two nights, the child is usually able to adapt and can be given normal shoes to wear when the brace is not needed. The abduction brace is only used after the clubfoot deformity has been fully corrected with a series of casts, sometimes in conjunction with a release of the Achilles tendon. Even after complete correction, clubfoot can recur before the child reaches the age of 4 years. The abduction brace is currently the only treatment that prevents the recurrence of clubfoot and is 95% effective in children who wear it in accordance with the doctor’s instructions. The use of the brace does not affect the development of the child’s motor system, nor does it affect the child’s ability to sit, crawl or walk alone. 4. Long-term follow-up After complete correction of clubfoot, outpatient follow-up is required every 3-4 months for 2 years, after which the follow-up period can be extended. According to the severity of clubfoot, the doctor will judge the wearing time of the brace and the possibility of recurrence. Do not end the treatment too early. Follow up every year until the child is 8-10 years old to determine the long-term effect of the treatment and whether there is a tendency of recurrence. If relapse occurs within 2-3 years of treatment, weekly pulling and casting can be repeated. Occasionally, a second Achilles tendon dissection may be necessary. In some cases, even if the brace is worn strictly according to medical advice, it is possible that surgery may be required to treat residual deformity after the age of 3 years. Severe clubfoot Although the Ponseti treatment is effective and avoids the need for extensive release surgery, approximately 5-10% of children are born with severe and rigid clubfoot, which usually responds poorly to or does not respond to plaster cast orthotics. These children can be tried with plaster casts, but if this fails, surgery is required. 7. Frequently asked questions Do children with clubfoot have sequelae in the future? Children with horseshoe feet, when treated with regular ponseti cast orthotics, usually achieve almost normal foot appearance and function. There may be a slight difference on closer inspection. The treated clubfoot is usually smaller than the contralateral foot and the lower leg is slightly thinner compared to the contralateral foot. If the initial deformity of the clubfoot is more severe, the difference from the normal side of the foot and lower leg will be more pronounced after treatment. Sometimes there is a mild shortening of the affected limb, but usually the difference is not significant and does not affect the function of the limb. Can babies with clubfoot exercise normally? Children treated with Ponseti cast orthotics are able to participate in sports as well as other normal children, and there are famous athletes who have had clubfoot.