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Congenital clubfoot is the second most common deformity of the locomotor system. This defect is easy to recognize due to the characteristic shape of the foot. This deformity occurs in several varieties, therefore early diagnosis of the type of deformity is important for determining the treatment method and prognosis.
What is Congenital Clubfoot?
Congenital clubfoot is a deformity of the musculoskeletal system that may affect both feet or accompanied by other defects. The diagnosis of this ailment is not difficult because it is characterized by the characteristic shape of the foot. The deformation includes plantar flexion of the foot, hollowing the longitudinal arch of the foot, the inner edge of the foot raised up, and adduction of the anterior part of the foot. In short, the baby’s feet, after birth, are directed inwards in a specific way and have a “sickle” shape. Clubfoot has several varieties, therefore its early diagnosis is important in selecting the appropriate type of therapy and affects the prognosis.
Clubfoot symptoms
A child suffering from this defect as a result of a short Achilles tendon has the heel raised up and the toes pointing downwards. At the same time, the heel is turned inwards and the foot appears to be contracted. The muscle contracture also makes the calves appear slimmer. To better visualize the clubfoot, compare it to the bottom of a golf club. The defect has different degrees of severity (the heavier the deformation, the finer the foot). Very rarely, deformation affects only one foot; it is more common in boys.
The causes of clubfoot formation
The causes of clubfoot have not been fully explained. Congenital deformity is related to the abnormal position of the limbs in the womb or the umbilical cord wrapping the feet or shins. However, only in some cases we can associate clubfoot with too tight position of the fetus in the womb, which in turn leads to incorrect positioning of the foot. Until some time, it was believed that the deformity was formed already in the embryo period, but now the theory that the defect is formed in the second trimester of pregnancy prevails.
Other possible causes of clubfoot formation:
- abnormalities in the lower section of the spinal cord, forming in the prenatal period;
- smoking and the use of ecstasy by pregnant women;
- the defect may also accompany other diseases, e.g. spina bifida, meningeal hernia or cerebral palsy.
In some cases clubfoot may present as an acquired condition. Then the risk factors are burns, acute inflammation or other injuries of the lower limbs.
IMPORTANT: Congenital clubfoot can run in families. Therefore, it is worth finding out if there have been any foot defects in the family in the past.
How to recognize and treat clubfoot?
Quick diagnosis of clubfoot and implementation of appropriate treatment significantly influences further prognosis. The defect can be detected during a routine ultrasound examination during pregnancy. Parents should learn more about this disease and choose institutions that treat this type of deformity. Treatment is best implemented right after the birth of the child, so it is worth looking for an experienced doctor who will take care of the child before delivery (each day of delay adversely affects the further prognosis, because an untreated defect worsens).
Importantly, the doctor cannot limit himself to examining the feet. During the first visit, he / she should completely undress the newborn and carefully inspect and examine its entire musculoskeletal system, including the hip joint. He should also look at how the lower limbs work, both individual fingers and the entire foot. The appearance of the lumbar and sacral regions is also important. Does the baby have discoloration? Is it excessively hairy? If abnormalities in the structure of the skeleton are felt by touch, developmental abnormalities of this section of the spine or spinal cord may be suspected.
As mentioned above, treatment should be carried out by an experienced orthopedist who corrects the defect gradually, systematically and without the use of force. Each time a correction is obtained, it must be stabilized until it is fully corrected. The persistence of any residual defect inevitably causes a recurrence of the deformity.
Treatment of Congenital Clubfoot is difficult, and the outcome of treatment depends not only on the skill of the doctor, but also on the diligence and patience of the parents, as well as their knowledge of the disease and the therapy itself.
Ponseti’s method in the treatment of clubfoot
It is a non-surgical method of treatment that was developed by Professor Ignacio Ponseti in the 50s. First, foot stretching exercises are performed, which simultaneously set it in the correct position, and then (in series) plaster dressings are applied. When the foot is in the optimal position, the horse stance is eliminated. Successively, using local anesthesia, the Achilles tendon is cut, which makes it possible to bend the foot, and then a plaster bandage is applied for a maximum of 12 weeks. After this time, the child is fitted with a special foot abduction brace to prevent recurrence of the deformity. The brace is only put on at night in toddlers who are just starting to learn to walk. Usually, it is recommended to be worn until the age of 4.
In older children, special stabilizers (orthoses) are an alternative.
Although non-surgical methods of treatment give great results, there are cases in which the only option is surgery. The procedure is usually performed after the age of six.
Older children can wear special orthoses, i.e. stabilizers. Non-surgical methods of clubfoot treatment bring great results, although sometimes the defect is so complicated that only surgery gives a chance for full recovery. It is usually performed after the age of six, so as not to disturb the proper growth of the foot.
After treatment, patients should stay under a doctor’s care for a long time, as the disease may recur (especially if the foot is still developing). The treatment result can be considered permanent when the foot bone does not deviate after its completion and during its growth, and the foot muscles function properly. Final assessment of the treatment result is possible only after the end of growth, but the first 5-7 years of the child’s life are decisive for further prognosis. Therefore, compliance with medical recommendations is important.