Guest guest Posted August 16, 2005 Report Share Posted August 16, 2005 If you would like a better copy of this in word format let me know and I will e-mail it to you. Clubfoot Handbook For Parents NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician. By Pearl Kingsley I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this: When you are going to have a baby, it's like planning a fabulous vacation trip to Italy. You buy a bunch of guidebooks and make your wonderful plans. The Coliseum. The Michelangelo . The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later the plane lands. The stewardess comes in and says, " Welcome to Holland. " " Holland?! " you say. " What do you mean Holland?? I signed up for Italy! I'm supposed to be in Italy. All my life I've dreamed of going to Italy. " But there has been a change in the flight plan. They've landed in Holland and there you must stay. The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine, and disease. It's just a different place. So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a new group of people you would have never met. It's just a different place. It's slower paced than Italy, less flashy than Italy. But after you've been there awhile and you catch your breath, you look around ... and you begin to notice that Holland has windmills ... and Holland has tulips. Holland even has Rembrants. But everyone you know is busy coming and going from Italy ... and they are all bragging about what a wonderful time they had there. And for the rest of your life, you will say " Yes, that's where I was supposed to go. That's what I had planned. " And the pain of that will never, ever, ever, ever go away...because the loss of that dream is a very, very significant loss. But ... if you spent your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland. Introduction What do Olympic gold medalist figure skater Kristi Yamaguchi, Super Bowl Champion All-Pro quarterback Troy Aikman, actor-writer-musician- composer Dudley , Hall of Fame sports announcer Pat Sumerall, romantic poet Lord Byron, comedian-actor-writer-director Damon Wayans, British King III, Heisman trophy winner Woodson, and Olympic gold medalist pioneering women's soccer star Mia Hamm all have in common? You've already guessed. They were all born with clubfeet! The medical term for clubfoot is Congenital Talipes Equinovarus. Congenital means a deformity that is present at birth. Talipes refers to the foot and Equinovarus means the position of the foot, which points downwards and inwards. Clubfoot can involve one foot (unilateral) or both feet (bilateral). The affected foot tends to be smaller than normal and can be shortened by up to 1 cm as compared to the normal side. In addition, some children with clubfoot have stiffness (i.e. lack of mobility in some of the joints of the foot) and small calf muscles. With adequate treatment, it is very likely that the deformity can be corrected and that your child will be able to walk well on the affected foot. Some elements of the deformity, however, may never go away. this includes the smallness of the foot, the small calf muscles, and the shortening of certain tendon. These rarely change a child's overall functional ability. Parents of infants born with clubfeet may be reassured that their baby, if otherwise normal, when treated by expert hands will have normal looking feet with normal function for all practical purposes. The well-treated clubfoot is no handicap and is fully compatible with a normal, active life. What Causes Clubfoot? Anyone can be born with clubfoot. Approximately 1 in 1000 people are born with clubfoot. In half of the cases, both feet are affected. When this happens, one foot is usually affected more than the other. It can run in families and is slightly more common in boys. Most children born with clubfoot have no other congenital problems, but sometimes clubfoot occurs in association with other abnormalities or syndromes. Clubfoot has been known about for many years and occurs worldwide, however very little is known about the cause. In rare instances a child born with myelomeningocele (spina bifida) or arthrogryposis may also have clubfeet. Beyond these observations, no actual cause is known. If your child has clubfoot, it is usually not due to anything you did or did not do during pregnancy. The condition can be detected pre-natally by ultrasound scan, but is often not discovered until birth. Clubfoot can be recognized in the infant by examination. The foot is inturned, stiff and cannot be brought to a normal position. Children with the condition should be referred to an orthopedic surgeon for complete evaluation and treatment of the deformity. During development, the posterior and medial tendons and ligaments (in the back and inside) of the foot fail to keep pace with the development of the rest of the foot. As a result, these tendons and ligaments tether the posterior and medial parts of the foot down, causing the foot to point downwards and the twist inwards. The bones of the feet are therefore held in that abnormal position. Over time, if uncorrected, the bones will become mis-shapened. There are three main types of defects: Equinovarus - This is the most severe type. The foot is twisted inward and downward so that the child cannot place the sole flat on the ground but must walk on the ball, the side, or even the top of the foot. Calcaneus valgus - In this moderately severe form, the foot is angled upward and outward so that the child has to walk on the heel or the inner side of the foot. Metatarsus varus or adductus - The mildest form of defect does not involve the ankle but only the bones and connective tissues of the foot, causing the front part to turn inward. Treatment Options Treatment should be commenced soon after birth, and the aim is to achieve functional, pain free feet. The treatment of clubfoot is rather involved, and best managed by Orthopedic surgeons experienced in the techniques mentioned below. Physiotherapy This is rarely used by itself, but can be useful for very mild cases. The aim is to stretch the ligaments and tendons into the correct position. You may be taught the technique to continue at home. Strapping Strips of adhesive strapping are passed around the foot, up the sides of the leg, and over the top of the knee, to hold the foot in a corrected position. This is usually done weekly, following some physiotherapy. Again, this can be useful for fairly mild cases, as it is generally ineffective after about 3 months. By this time the kicks are so strong that the strapping stretches very quickly, and is also liable to come off. Traditional Casting It is very important to treat clubfoot and do so as early as possible (i.e. shortly after birth) to prevent disability and problems with walking when the child gets older. Clubfoot can be treated so that the deformity is corrected and normal function, for the most part, is restored. The first step in management is taping or casting of the foot. The physician holds the foot in the proper position and then puts tape or cast on to hold it in place. One-third of feet, usually the ones more mildly affected, will respond to this therapy. During the immediate postnatal period, the cast or tapings are changed every day. Thereafter, your child will be seen frequently by the pediatric orthopedic surgeon: every one to two weeks. Initial treatment is provided by a series of casts to the affected foot (feet). Infants are placed in casts covering the entire limb(s). The severity of your child's deformity will determine the number of casts required. In more severe cases, your child may also require tendon lengthening or surgical correction. Most daily activities are not hampered by cast wear. Bathing is one exception. Your baby will, in most cases, not be able to be dipped into water. The casts will need to be kept dry. Diaper changing is not altered. After multiple serial castings are completed (2-3 months), special shoes with or without a bar may be needed. Ponseti Method The majority of clubfeet can be corrected in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts. The treatment is based on a sound understanding of the functional anatomy of the foot and of the biological response of muscles, ligaments and bone to corrective position changes gradually obtained by manipulation and casting. Less than 5% of infants born with clubfeet may have very severe, short, plump feet with stiff ligaments, unyielding to stretching. These babies may need surgical correction. The results are better if bone and joint surgery can be avoided altogether. Surgery in the clubfoot is invariably followed by scarring, stiffness and muscle weakness which becomes more severe and disabling after adolescence. The treatment should begin in the first week or two of life in order to take advantage of the favorable elasticity of the tissues forming the ligaments joint capsules and tendons. With our treatment these structures are stretched with weekly, gentle manipulations. A plaster cast is applied after each weekly session to retain the degree of correction obtained and to soften the ligaments. Thereby, the displaced bones are gradually brought into the correct alignment. Five to seven plaster casts extending from the toes to the upper thigh with the knees at right angle should be sufficient to correct the clubfoot deformity. Even the very stiff feet require no more than 8 or 9 plaster casts to obtain maximum correction. Before applying the last plaster cast which is to be worn for three weeks, the Achilles tendon is often cut in an office procedure to complete the correction of the foot. By the time the cast is removed the tendon has regenerated to a proper length. After two months of treatment the foot should appear overcorrected. Following correction the clubfoot deformity tends to relapse. To prevent relapses, when the last plaster cast is removed a splint (FAB) must be worn full-time for two to three months and thereafter at night for 2 to 4 years. The splint consists of a bar (the length of which is the distance between the baby's shoulders) with high top open-toed shoes attached at the ends of the bar in about 70 degrees of external rotation. The baby may feel uncomfortable at first when trying to alternatively kick the legs. However, the baby soon learns to kick both legs simultaneously and feels comfortable. In children with only one clubfoot, the shoe for the normal foot is fixed on the bar in 40 degrees of external rotation. Since the surgeon can feel with his fingers the position of the bones and the degree of correction, X-rays of the feet are not necessary except in complex cases. When the deformity relapses in spite of proper splinting a simple operation may be needed when the child is over two years of age. The operation consists in transferring the anterior tibial tendon to the third cuneiform. Poor results of cast and manipulative treatments of clubfeet in many clinics indicate that the attempts at correction have been inadequate because the techniques used are flawed. Without a thorough understanding of the anatomy and kinematics of the normal foot and of the deviation of the bones in the clubfoot, the deformity is difficult to correct. Poorly conducted manipulations and casting will further compound the clubfoot deformity rather than correct it making treatment difficult or impossible. Surgeons with limited experience in the treatment of clubfoot should not attempt to correct the deformity. They may succeed in correcting mild clubfeet, but the severe cases require experienced hands. Referral to a center with expertise in the non-surgical correction of clubfoot should be sought before considering surgery. More information regarding the Ponseti Method can be found on Dr. Ponseti's website: http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html Splinting Splinting can be used at various times of your child's treatment, and are often used as a follow-up after serial casting, or after casts applied at surgery. Splints are either the denis browne type where the feet and lower leg are splinted, and then attached to a bar which can be adjusted gently daily, until eventually the feet are in the correct position, or Ankle-foot orthoses (AFO's), which are a light- weight, plastic splint held on by velcro. These can be worn 24 hours a day, or at night only. They can be removed easily for bathing. Shoes that may be used after splints are straight last shoes where the medial border is straight. French Physio Method French technique consists of daily visits with the physical therapist. Gentle, painless stretching of the foot is performed. The foot is then taped to maintain the improved position and is held this way until just before the next day's visit. At night, the taped foot is placed into a continuous passive motion machine at home in order to maximize the amount of stretching. This is tolerated well by the infants. The tape is removed for two hours each day to allow for bathing, airing of the skin, and home exercises. Removable aquaplast splints are also used to reinforce the taped position. The one-hour physical therapy sessions are conducted five days each week for as long as three months (in very stiff feet). Taping is discontinued when the child starts to walk. Surgery If cast treatment fails, surgery may be necessary. This is not performed until the child is between four and eight months of age. The Pediatric Orthopaedic Surgeon lengthens several of the tendons (structures which connect muscle to bone) which allows to foot to adopt a normal position. One of the most common operative procedures is a `soft tissue release', carried out to correct the short tendons and ligaments which pull the foot out of position. It involves lengthening the Achilles tendon, as well as any other involved ligaments. The usual routine is to then plaster the foot for 2 weeks, but only in a semi-corrected position. This allows the wound to heal, without putting stress on the stitches. After 2 weeks the stitches are removed, and the foot is once again put in plaster - this time in a fully corrected position. This plaster is usually kept on for around 6 weeks, after which time the foot is reviewed. If the foot is not fully corrected, the plaster may be reapplied, or a splint may be used. The timing of the surgery will vary, according to your surgeon. Some will operate on very young babies, but most surgeons feel that this is not very effective, and that there is also a risk of `over- correcting'. The majority seem to like to operate at around 9 months, with the belief that when the casts come off the child should be ready to start walking on the foot, and this can help maintain the correction. However, there are some surgeons that feel that surgery should be carried out as late as possible. Retention and Follow-up Whether correction is accomplished by casting or by operative therapy, splinting at night may be used to prevent a recurrence of the deformity. Corrective shoes have little benefit in preventing recurrence and thus normal shoes are allowed during the day. Exercises too are insufficient as the only treatment for recurrence, but some believe that stretching may be of some benefit. Children need regular follow-up for several years after treatment (casting or surgery) to make sure that the clubfoot does not come back. The idiopathic type (i.e. the cause is unknown) clubfoot can come back up to about six or seven years of age. Most, however, if they do return will do so within several years of treatment. Repeat casting or further surgery can be performed. Tips & Tricks SOAKING PLASTER CASTS OFF: & #61656; Soak baby's cast in a tubful of warm water and a little vinegar or lemon juice until softened, then peel away, & #61656; Put warm wet facecloths or towels over the casts and cover with a Ziploc or bread bag. Plan baby's favorite activities: give milk/formula, baby swing, anything to keep happy while casts are softening. After an hour, casts should be able to be pealed right off. & #61656; Fill a small bulb syringe with warm water and syringe the water inside the cast to soak it off from the inside. Do this for about & #189; hour, then 10 minutes in the tub should get the casts off. KEEPING CASTS CLEAN: & #61656; Keep cast clean and dry. If it gets dirty, clean it with a damp cloth. Wipe off extra moisture and allow the cast to air dry. (9) & #61656; Be sure to put a sock over the cast to keep it clean and to keep your baby's toes warm. Try using adult or toddler socks to fit over the casts. You can cut them down or just roll them down to fit. CHECK BABY'S FEET REGULARLY: Check your baby's toes several times a day. They should be pink and warm. Call your doctor if: & #61656; the toes are swollen. & #61656; the toes are white or purple & #61656; the skin near the edges of the cast is red or scratched & #61656; the cast is too tight & #61656; the cast is cracked & #61656; the cast gets wet & #61656; you notice a bad smell coming from inside the cast HOW TO DRESS BABY: During casting any type of pants with wide legs is, of course, going to work better for you. Sweats are wonderful, however most clothing works fine over casts. Stock up on clothing with snaps in the crotch for time in the FAB. If you're handy at the sewing machine, you can open up the seams and perhaps add snaps. Helpful Links Dr Ponseti's site: http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html http://www.global-help.org/publications/ponseti-cf.html A list of multiple links for Ponseti Method: http://pages.ivillage.com/ponseti_links/ A list of multiple links for clubfeet: http://www.internet-health- directory.com/Conditions_and_Diseases_Musculoskeletal_Disorders_Congen ital_Anomalies_Clubfoot.html Clubfoot info: http://www.xprss.com/clubfoot/welcome.asp Brace: http://www.mdorthopaedics.org/default.html Markell shoes: http://www.markellshoe.com Plantaris feet: http://adifferentfoot.freeservers.com/ No-surgery board http://health.groups.yahoo.com/group/nosurgery4clubfoot Photo group http://health.groups.yahoo.com/group/CFPics/ Clubfoot Exchange http://health.groups.yahoo.com/group/TheClubfootSwap/ Hints and Tips: http://ponseticlubfoot.freeservers.com/hints.html Foundations: http://www.pediatric-orthopedic-foundation.org/ Mc house IC http://www.uihealthcare.com/depts/ronaldmcdonald/index.html NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician. References www.clubfoot.co.uk http://www.drgreene.com/21_1048.html http://www.scoi.com/clubfoot.htm http://www.orthoseek.com/articles/clubfoot.html http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html http://www.hopkinsmedicine.org/orthopedicsurgery/peds/clubfoot.html http://webhome.idirect.com/~kathrynh/clubfoot.html http://xprss.com/clubfoot/default.asp Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2005 Report Share Posted August 16, 2005 If you would like a better copy of this in word format let me know and I will e-mail it to you. Clubfoot Handbook For Parents NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician. By Pearl Kingsley I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this: When you are going to have a baby, it's like planning a fabulous vacation trip to Italy. You buy a bunch of guidebooks and make your wonderful plans. The Coliseum. The Michelangelo . The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later the plane lands. The stewardess comes in and says, " Welcome to Holland. " " Holland?! " you say. " What do you mean Holland?? I signed up for Italy! I'm supposed to be in Italy. All my life I've dreamed of going to Italy. " But there has been a change in the flight plan. They've landed in Holland and there you must stay. The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine, and disease. It's just a different place. So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a new group of people you would have never met. It's just a different place. It's slower paced than Italy, less flashy than Italy. But after you've been there awhile and you catch your breath, you look around ... and you begin to notice that Holland has windmills ... and Holland has tulips. Holland even has Rembrants. But everyone you know is busy coming and going from Italy ... and they are all bragging about what a wonderful time they had there. And for the rest of your life, you will say " Yes, that's where I was supposed to go. That's what I had planned. " And the pain of that will never, ever, ever, ever go away...because the loss of that dream is a very, very significant loss. But ... if you spent your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland. Introduction What do Olympic gold medalist figure skater Kristi Yamaguchi, Super Bowl Champion All-Pro quarterback Troy Aikman, actor-writer-musician- composer Dudley , Hall of Fame sports announcer Pat Sumerall, romantic poet Lord Byron, comedian-actor-writer-director Damon Wayans, British King III, Heisman trophy winner Woodson, and Olympic gold medalist pioneering women's soccer star Mia Hamm all have in common? You've already guessed. They were all born with clubfeet! The medical term for clubfoot is Congenital Talipes Equinovarus. Congenital means a deformity that is present at birth. Talipes refers to the foot and Equinovarus means the position of the foot, which points downwards and inwards. Clubfoot can involve one foot (unilateral) or both feet (bilateral). The affected foot tends to be smaller than normal and can be shortened by up to 1 cm as compared to the normal side. In addition, some children with clubfoot have stiffness (i.e. lack of mobility in some of the joints of the foot) and small calf muscles. With adequate treatment, it is very likely that the deformity can be corrected and that your child will be able to walk well on the affected foot. Some elements of the deformity, however, may never go away. this includes the smallness of the foot, the small calf muscles, and the shortening of certain tendon. These rarely change a child's overall functional ability. Parents of infants born with clubfeet may be reassured that their baby, if otherwise normal, when treated by expert hands will have normal looking feet with normal function for all practical purposes. The well-treated clubfoot is no handicap and is fully compatible with a normal, active life. What Causes Clubfoot? Anyone can be born with clubfoot. Approximately 1 in 1000 people are born with clubfoot. In half of the cases, both feet are affected. When this happens, one foot is usually affected more than the other. It can run in families and is slightly more common in boys. Most children born with clubfoot have no other congenital problems, but sometimes clubfoot occurs in association with other abnormalities or syndromes. Clubfoot has been known about for many years and occurs worldwide, however very little is known about the cause. In rare instances a child born with myelomeningocele (spina bifida) or arthrogryposis may also have clubfeet. Beyond these observations, no actual cause is known. If your child has clubfoot, it is usually not due to anything you did or did not do during pregnancy. The condition can be detected pre-natally by ultrasound scan, but is often not discovered until birth. Clubfoot can be recognized in the infant by examination. The foot is inturned, stiff and cannot be brought to a normal position. Children with the condition should be referred to an orthopedic surgeon for complete evaluation and treatment of the deformity. During development, the posterior and medial tendons and ligaments (in the back and inside) of the foot fail to keep pace with the development of the rest of the foot. As a result, these tendons and ligaments tether the posterior and medial parts of the foot down, causing the foot to point downwards and the twist inwards. The bones of the feet are therefore held in that abnormal position. Over time, if uncorrected, the bones will become mis-shapened. There are three main types of defects: Equinovarus - This is the most severe type. The foot is twisted inward and downward so that the child cannot place the sole flat on the ground but must walk on the ball, the side, or even the top of the foot. Calcaneus valgus - In this moderately severe form, the foot is angled upward and outward so that the child has to walk on the heel or the inner side of the foot. Metatarsus varus or adductus - The mildest form of defect does not involve the ankle but only the bones and connective tissues of the foot, causing the front part to turn inward. Treatment Options Treatment should be commenced soon after birth, and the aim is to achieve functional, pain free feet. The treatment of clubfoot is rather involved, and best managed by Orthopedic surgeons experienced in the techniques mentioned below. Physiotherapy This is rarely used by itself, but can be useful for very mild cases. The aim is to stretch the ligaments and tendons into the correct position. You may be taught the technique to continue at home. Strapping Strips of adhesive strapping are passed around the foot, up the sides of the leg, and over the top of the knee, to hold the foot in a corrected position. This is usually done weekly, following some physiotherapy. Again, this can be useful for fairly mild cases, as it is generally ineffective after about 3 months. By this time the kicks are so strong that the strapping stretches very quickly, and is also liable to come off. Traditional Casting It is very important to treat clubfoot and do so as early as possible (i.e. shortly after birth) to prevent disability and problems with walking when the child gets older. Clubfoot can be treated so that the deformity is corrected and normal function, for the most part, is restored. The first step in management is taping or casting of the foot. The physician holds the foot in the proper position and then puts tape or cast on to hold it in place. One-third of feet, usually the ones more mildly affected, will respond to this therapy. During the immediate postnatal period, the cast or tapings are changed every day. Thereafter, your child will be seen frequently by the pediatric orthopedic surgeon: every one to two weeks. Initial treatment is provided by a series of casts to the affected foot (feet). Infants are placed in casts covering the entire limb(s). The severity of your child's deformity will determine the number of casts required. In more severe cases, your child may also require tendon lengthening or surgical correction. Most daily activities are not hampered by cast wear. Bathing is one exception. Your baby will, in most cases, not be able to be dipped into water. The casts will need to be kept dry. Diaper changing is not altered. After multiple serial castings are completed (2-3 months), special shoes with or without a bar may be needed. Ponseti Method The majority of clubfeet can be corrected in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts. The treatment is based on a sound understanding of the functional anatomy of the foot and of the biological response of muscles, ligaments and bone to corrective position changes gradually obtained by manipulation and casting. Less than 5% of infants born with clubfeet may have very severe, short, plump feet with stiff ligaments, unyielding to stretching. These babies may need surgical correction. The results are better if bone and joint surgery can be avoided altogether. Surgery in the clubfoot is invariably followed by scarring, stiffness and muscle weakness which becomes more severe and disabling after adolescence. The treatment should begin in the first week or two of life in order to take advantage of the favorable elasticity of the tissues forming the ligaments joint capsules and tendons. With our treatment these structures are stretched with weekly, gentle manipulations. A plaster cast is applied after each weekly session to retain the degree of correction obtained and to soften the ligaments. Thereby, the displaced bones are gradually brought into the correct alignment. Five to seven plaster casts extending from the toes to the upper thigh with the knees at right angle should be sufficient to correct the clubfoot deformity. Even the very stiff feet require no more than 8 or 9 plaster casts to obtain maximum correction. Before applying the last plaster cast which is to be worn for three weeks, the Achilles tendon is often cut in an office procedure to complete the correction of the foot. By the time the cast is removed the tendon has regenerated to a proper length. After two months of treatment the foot should appear overcorrected. Following correction the clubfoot deformity tends to relapse. To prevent relapses, when the last plaster cast is removed a splint (FAB) must be worn full-time for two to three months and thereafter at night for 2 to 4 years. The splint consists of a bar (the length of which is the distance between the baby's shoulders) with high top open-toed shoes attached at the ends of the bar in about 70 degrees of external rotation. The baby may feel uncomfortable at first when trying to alternatively kick the legs. However, the baby soon learns to kick both legs simultaneously and feels comfortable. In children with only one clubfoot, the shoe for the normal foot is fixed on the bar in 40 degrees of external rotation. Since the surgeon can feel with his fingers the position of the bones and the degree of correction, X-rays of the feet are not necessary except in complex cases. When the deformity relapses in spite of proper splinting a simple operation may be needed when the child is over two years of age. The operation consists in transferring the anterior tibial tendon to the third cuneiform. Poor results of cast and manipulative treatments of clubfeet in many clinics indicate that the attempts at correction have been inadequate because the techniques used are flawed. Without a thorough understanding of the anatomy and kinematics of the normal foot and of the deviation of the bones in the clubfoot, the deformity is difficult to correct. Poorly conducted manipulations and casting will further compound the clubfoot deformity rather than correct it making treatment difficult or impossible. Surgeons with limited experience in the treatment of clubfoot should not attempt to correct the deformity. They may succeed in correcting mild clubfeet, but the severe cases require experienced hands. Referral to a center with expertise in the non-surgical correction of clubfoot should be sought before considering surgery. More information regarding the Ponseti Method can be found on Dr. Ponseti's website: http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html Splinting Splinting can be used at various times of your child's treatment, and are often used as a follow-up after serial casting, or after casts applied at surgery. Splints are either the denis browne type where the feet and lower leg are splinted, and then attached to a bar which can be adjusted gently daily, until eventually the feet are in the correct position, or Ankle-foot orthoses (AFO's), which are a light- weight, plastic splint held on by velcro. These can be worn 24 hours a day, or at night only. They can be removed easily for bathing. Shoes that may be used after splints are straight last shoes where the medial border is straight. French Physio Method French technique consists of daily visits with the physical therapist. Gentle, painless stretching of the foot is performed. The foot is then taped to maintain the improved position and is held this way until just before the next day's visit. At night, the taped foot is placed into a continuous passive motion machine at home in order to maximize the amount of stretching. This is tolerated well by the infants. The tape is removed for two hours each day to allow for bathing, airing of the skin, and home exercises. Removable aquaplast splints are also used to reinforce the taped position. The one-hour physical therapy sessions are conducted five days each week for as long as three months (in very stiff feet). Taping is discontinued when the child starts to walk. Surgery If cast treatment fails, surgery may be necessary. This is not performed until the child is between four and eight months of age. The Pediatric Orthopaedic Surgeon lengthens several of the tendons (structures which connect muscle to bone) which allows to foot to adopt a normal position. One of the most common operative procedures is a `soft tissue release', carried out to correct the short tendons and ligaments which pull the foot out of position. It involves lengthening the Achilles tendon, as well as any other involved ligaments. The usual routine is to then plaster the foot for 2 weeks, but only in a semi-corrected position. This allows the wound to heal, without putting stress on the stitches. After 2 weeks the stitches are removed, and the foot is once again put in plaster - this time in a fully corrected position. This plaster is usually kept on for around 6 weeks, after which time the foot is reviewed. If the foot is not fully corrected, the plaster may be reapplied, or a splint may be used. The timing of the surgery will vary, according to your surgeon. Some will operate on very young babies, but most surgeons feel that this is not very effective, and that there is also a risk of `over- correcting'. The majority seem to like to operate at around 9 months, with the belief that when the casts come off the child should be ready to start walking on the foot, and this can help maintain the correction. However, there are some surgeons that feel that surgery should be carried out as late as possible. Retention and Follow-up Whether correction is accomplished by casting or by operative therapy, splinting at night may be used to prevent a recurrence of the deformity. Corrective shoes have little benefit in preventing recurrence and thus normal shoes are allowed during the day. Exercises too are insufficient as the only treatment for recurrence, but some believe that stretching may be of some benefit. Children need regular follow-up for several years after treatment (casting or surgery) to make sure that the clubfoot does not come back. The idiopathic type (i.e. the cause is unknown) clubfoot can come back up to about six or seven years of age. Most, however, if they do return will do so within several years of treatment. Repeat casting or further surgery can be performed. Tips & Tricks SOAKING PLASTER CASTS OFF: & #61656; Soak baby's cast in a tubful of warm water and a little vinegar or lemon juice until softened, then peel away, & #61656; Put warm wet facecloths or towels over the casts and cover with a Ziploc or bread bag. Plan baby's favorite activities: give milk/formula, baby swing, anything to keep happy while casts are softening. After an hour, casts should be able to be pealed right off. & #61656; Fill a small bulb syringe with warm water and syringe the water inside the cast to soak it off from the inside. Do this for about & #189; hour, then 10 minutes in the tub should get the casts off. KEEPING CASTS CLEAN: & #61656; Keep cast clean and dry. If it gets dirty, clean it with a damp cloth. Wipe off extra moisture and allow the cast to air dry. (9) & #61656; Be sure to put a sock over the cast to keep it clean and to keep your baby's toes warm. Try using adult or toddler socks to fit over the casts. You can cut them down or just roll them down to fit. CHECK BABY'S FEET REGULARLY: Check your baby's toes several times a day. They should be pink and warm. Call your doctor if: & #61656; the toes are swollen. & #61656; the toes are white or purple & #61656; the skin near the edges of the cast is red or scratched & #61656; the cast is too tight & #61656; the cast is cracked & #61656; the cast gets wet & #61656; you notice a bad smell coming from inside the cast HOW TO DRESS BABY: During casting any type of pants with wide legs is, of course, going to work better for you. Sweats are wonderful, however most clothing works fine over casts. Stock up on clothing with snaps in the crotch for time in the FAB. If you're handy at the sewing machine, you can open up the seams and perhaps add snaps. Helpful Links Dr Ponseti's site: http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html http://www.global-help.org/publications/ponseti-cf.html A list of multiple links for Ponseti Method: http://pages.ivillage.com/ponseti_links/ A list of multiple links for clubfeet: http://www.internet-health- directory.com/Conditions_and_Diseases_Musculoskeletal_Disorders_Congen ital_Anomalies_Clubfoot.html Clubfoot info: http://www.xprss.com/clubfoot/welcome.asp Brace: http://www.mdorthopaedics.org/default.html Markell shoes: http://www.markellshoe.com Plantaris feet: http://adifferentfoot.freeservers.com/ No-surgery board http://health.groups.yahoo.com/group/nosurgery4clubfoot Photo group http://health.groups.yahoo.com/group/CFPics/ Clubfoot Exchange http://health.groups.yahoo.com/group/TheClubfootSwap/ Hints and Tips: http://ponseticlubfoot.freeservers.com/hints.html Foundations: http://www.pediatric-orthopedic-foundation.org/ Mc house IC http://www.uihealthcare.com/depts/ronaldmcdonald/index.html NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician. References www.clubfoot.co.uk http://www.drgreene.com/21_1048.html http://www.scoi.com/clubfoot.htm http://www.orthoseek.com/articles/clubfoot.html http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html http://www.hopkinsmedicine.org/orthopedicsurgery/peds/clubfoot.html http://webhome.idirect.com/~kathrynh/clubfoot.html http://xprss.com/clubfoot/default.asp Quote Link to comment Share on other sites More sharing options...
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