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Is your child in need of clubfoot ponseti treatment?
Treating clubfoot in newborn babies can be very daunting for parents, but you don’t have to worry now. Consult Dr. Assad, Specialist Pediatric Orthopedic Doctor, well experienced in the Ponseti Method for newborn clubfoot correction. Take the first step towards providing your child with the best possible orthopedic care. Your child’s mobility and comfort are our priorities, and we’re here to support you every step of the way.
Dr. Qureshi, pediatric orthopedic specialist, explains that clubfoot, a prevalent lower limb issue in children, impacts around 1 in 1000 births. While it may have a hereditary component, it primarily affects healthy children without other health concerns, termed idiopathic clubfoot (unknown cause). Although most newborns have feet resembling club feet, they can usually be easily stretched straight. Idiopathic clubfoot is characterized by a certain degree of stiffness and resistance to stretching. It may affect one or both feet and can also occur in neuromuscular conditions such as cerebral palsy, arthrogryposis, and spina bifida, presenting with a stiffer and more resistant deformity.
Clubfoot can often be diagnosed through antenatal scanning. Dr. Qureshi offers an antenatal counselling service where he will discuss the diagnosis and outline the principles of treatment. This can be very reassuring to parents in the run-up to the birth where concerns about the impact of the condition and success of treatment can significantly detract from the joy of the impending arrival of the newborn.
The globally recognized approach for treating idiopathic clubfoot is the Ponseti method, following a well-established protocol of plaster cast changes to gradually straighten the foot. Treatment typically commences soon after birth, once the baby’s weight stabilizes and there are no other health concerns. It involves weekly visits for foot manipulation and cast application, progressively improving the foot’s position. A scoring system evaluates the foot’s appearance, guiding treatment adjustments. The final step involves a clinical procedure where the tight heel cord is divided to bring the foot up, and the last cast is applied. This clinic procedure, conducted with local anesthesia and pre-applied cream for comfort, is widely accepted as the global standard. The final cast remains for three weeks to allow tendon healing, with the number of casts varying based on foot stiffness, typically ranging from three to eight casts, averaging around five.
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Case A : 9 day old with left side clubfoot
After the foot is successfully corrected on completion of the cast treatment, it needs to be braced with an external appliance consisting of specialized boots attached to a bar. This is to ensure that the feet do not slip back into the deformity with growth. The boots and bar are worn for 23 hours a day for the first three months. Thereafter they are applied for 12 hours a day usually at night time. The bracing phase of treatment is very important as without it the feet will relapse back towards the original deformity over time. The bracing phase needs to be continued for the first few years of life, usually up to age 4 to 5 years. If the feet are adequately corrected this period is tolerated well by the child and does not interfere with or delay the onset of walking. Frequent follow-up throughout growth is very important to detect any early signs of relapse. Despite optimal treatment and successful deformity correction following casting, relapse can happen in any child at any age.
Most cases of relapse where the foot starts to curve inward again can be treated with repeat casting. However, in older children, once the bracing period is over, relapse may be better addressed with muscle rebalancing surgery. This is discussed in the following section.