Diagnosis
Clubfoot may be diagnosed during pregnancy by ultrasound. It may occur alone or with other defects. It can affect one foot or both feet.
Clubfoot, or talipes equinovarus , is a fairly common birth defect in which the foot points downward and twists inward. Clubfoot can be mild or severe, and can involve one foot or both. The condition is not painful. It poses no effect until the child begins to stand. If left untreated, the foot can’t move normally. If both feet are affected, the child will walk on the sides or tops of his or her feet, possibly causing infection, calluses or arthritis.
Treatment
Ponseti method is the casting technique used at Nationwide Children’s Hospital. Each patient, whether they have a flexible, semi-flexible or rigid clubfoot, first gets manipulation and cast application. This begins sometime within the first week of life. The casts are usually changed weekly in the clinic setting for 5–6 weeks. The orthopedic physician will determine if the casts have corrected the foot. Once casting ends, the patient is fitted with orthotic shoes connected to a bar. The specialized shoes are called Dennis Browne shoes.
Complication
Sometimes using casts does not correct the foot enough. In these cases, a tenotomy procedure needs to be performed. In it, the orthopedic surgeon cuts the Achilles tendon. The foot is then recast until the Dennis Browne shoes can be made. The Achilles tendon regrows within weeks.
Recovery
Once the patient is in the Dennis Browne shoes, they are worn 24 hours a day, excluding bath time for 3-4 months. Afterwards, the shoes are only worn at nap time and at night until around age 2. This allows the child to learn to stand and walk when he or she is awake. Later, the shoes are only worn at night time until age 4–5. The recurrence rate is much lower when parents follow the suggested guidelines. However, there is always a chance that further surgery will be needed, even when a family follows all the guidelines.