What is  a club foot?

​

Clubfoot is a congenital deformity of the foot. “Congenital” means the condition is present at birth. The complex misalignment with inwardly turned feet involves various individual components, knowledge of which is relevant for therapy.

 

Most children born with club feet have no other congenital problems. However, club feet can be associated with other abnormalities,

 

Without medical treatment, clubfoot cannot be expected to improve spontaneously. However, since there are good treatment options, clubfoot does not have to be accepted as fate.

 

​

What are possible causes of club feet?

​

There are various factors (position in the womb, amount of amniotic fluid, neurological causes, genetic causes) that can promote the development of club feet. However, the actual mechanism of formation is still unknown. There are also families in which club feet occur more frequently. In these cases, a genetic cause can be assumed.

 

At a certain point before birth, parts of the foot bones and muscles stop growing, so that the shape of the foot changes to a club foot. This form is probably also favored by the position of the baby in the mother's stomach. The majority of children who are born with club feet show no other abnormalities. Nevertheless, it is important to recognize or rule out any additional abnormalities early after birth.

 

​

Basic principles of clubfoot treatment

​

The goal of treatment is this

• to return the foot to a normal position (redression phase) and

• to maintain the correction achieved (retention phase)

 

​

When is the best time to start therapy?

​

Treatment does not need to be started immediately after birth. Ideally, plaster therapy should be started within 7-14 days after birth. If an early start of treatment was missed, therapy can still be started at a later date.

​

 

How are club feet treated?

​

Club feet are usually treated conservatively, i.e. without surgery.

The first part of the treatment is the so-called plaster redression therapy. The feet are gently manipulated every week and brought step by step towards their normal position. This requires weekly cast changes.

The international gold standard in the treatment of club feet is the Ponseti method. The misalignment is corrected through manipulation and weekly replacement of the casts. Most cases of congenital club feet in young children can be corrected within 5-7 weeks with this procedure. In about 80% of cases, a small outpatient procedure is necessary after redressal treatment to lengthen the Achilles tendon.  A cast is then applied for another 3 weeks to allow the Achilles tendon to heal in the corrected position.

 

Since the clubfoot can recur even after correction as the condition continues to grow, this must be prevented by so-called retention therapy. So-called foot abduction splints are usually used for this. These are used for both unilateral and bilateral clubfoot. The rails consist of shoes which are attached to an adjustable rail via a mechanism. This keeps the feet in the optimal position. Initially, the splints are worn for 23 hours a day for the first 3 months. During this time, the splints should only be removed for personal hygiene. After that, the splint should only be worn at night until the child reaches the age of 4. The majority of children tolerate this approach very well. Wearing the splint does not hinder the child's development in terms of sitting, crawling and walking.