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Has Your Child been diagnosed with Clubfoot Relapse?
Being told your child’s clubfoot problem has returned following successful newborn clubfoot Ponseti treatment can be very worrying for parents. Don’t worry, Dr. Assad is a clubfoot specialist with years of exeprience treating clubfoot relapse. We offer comprehensive assessment and patient specific treatment plans for clubfoot relapse. Dr Assad ensures your child’s foot and ankle health is restored with precision, care and compassion. Schedule a consultation today to ensure your child receives the best pediatric orthopedic care possible. We’re committed to supporting you through every phase of treatment.
Idiopathic clubfoot has the potential for relapse at any time, even after initial successful treatment and ongoing bracing. Relapse occurrences are unpredictable, underscoring the importance of structured follow-ups to identify early signs. Typically, in the first two years of life, children are monitored every three months while wearing boots and bars. From ages 2 to 4, follow-ups occur every four months, extending to every six months up to ages 8 to 10, as relapses may occasionally take several years to appear.
For specialized care of idiopathic clubfoot in Dubai, consult Dr. Qureshi, a renowned pediatric orthopedic surgeon who provides comprehensive treatment and regular follow-ups for effective management.
Early signs of relapse may manifest as the child developing intolerance to the boots and bars. In walking-age children, visual cues include the foot curving inward, with the heel pointing inwards when viewed from behind. Addressing relapses involves repeat Ponseti serial casting to stretch the deformity. In older children with initial successful treatment, a relapsed clubfoot may indicate muscle imbalance, causing the foot to deviate back toward the original deformity. This becomes apparent when the child points their foot up, and instead of pointing outwards, it points inwards. This is particularly observable during walking as dynamic supination of the forefoot during the swing phase of gait.
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Case A : 3 year old with relapsed clubfeet
In cases of relapse in older children, Dr. Qureshi usually advocates surgery to re-balance the muscle forces across the foot. As well as the tendency for the foot to turn inwards there is usually some accompanying calf muscle tightness. Dr. Qureshi’s treatment plan for idiopathic clubfoot relapse usually consists of the following elements:
- Ponseti serial casting to make the foot straight again if there is any resistance to stretching the foot straight.
- Tibialis anterior tendon transfer, which is a standard recommendation based on the Ponseti treatment protocol for relapse in older children. The tendon pulling the foot upwards and inwards is reattached at a different location on the top of the foot so that as the foot is brought upwards it deviates outwards rather than inwards.
- Percutaneous Tendo Achilles tenotomy, which is added by Dr. Qureshi to rebalance the muscle forces across the foot. Usually, the calf muscles are overly strong pointing the foot downwards. By releasing the Achilles tendon, the foot can be brought up to re-tension the tibialis anterior tendon at the transfer. In effect, restoring muscle balance by bolstering the strength of the muscle which pulls the foot up whilst attenuating the pull of the calf muscles pulling the foot down.
The results of surgery for idiopathic clubfoot, involving tibialis anterior tendon transfer and percutaneous tendo Achilles tenotomy,are highly favorable. This approach yields excellent function, providing a pain-free and flexible foot. This stands in stark contrast to classical clubfoot operations, which entail extensive joint and muscle releases to straighten the foot. While such traditional procedures persist, Dr. Qureshi refrains from employing them in his practice due to the enduring issues of pain and stiffness.
Case A : 9 year old with clubfoot relapse and tight calf muscles
