Description
Club foot (congenital talipes equinovarus) is a congenital foot abnormality where a child’s foot twists at the ankle, turning the foot inward.
Cause
Club foot may be associated with other problems in a child but is most often “idiopathic”, meaning we don’t know why the child developed the club foot.
Diagnosis Methods
Club foot is typically diagnosed during prenatal ultrasound screenings and/or noted during newborn examinations where the foot is often found to be rigidly turned in.
Treatment
In the past, 85% of infants with clubfoot underwent major surgery for treatment. I now rarely treat club foot with surgery and almost never in a child without an underlying disorder.
Non-surgical Treatment
Club foot in an otherwise healthy child can be effectively treated with minimally invasive procedures such as The Ponseti technique, an incredible method that was developed by the surgeon Ignacio Ponseti. The Ponseti technique uses a series of very specifically molded casts to guide a child’s club foot into the proper position. (There are other clubfoot casts but not every cast is a part of the Ponseti method.)
After meeting Dr. Ponseti and learning the method from him in 2000, Dr. Wallace Lehman and I created a Clubfoot Center . The New York Ponseti Clubfoot Center continues to be a vibrant and active location where Dr. Lehman and Dr. Alice Chu work to continuously improve and validate the life-long mission of Dr. Ponseti.
Surgical Treatment
Due to the effectiveness of the Ponseti method, full soft tissue releases are now almost never performed.
Some children with neuromuscular disorders such as spina bifida, severe arthrogryposis, Larsen syndrome, and some skeletal dysplasias can still undergo the Ponseti method but may need additional casts and/or surgery to obtain a longer lasting and better correction.
In the cases of older children minor procedures may be performed to make the foot more “normal”. However, these procedures are performed on less than 20% of children treated for clubfeet.
Anterior Tibial Tendon Transfer
This procedure is performed after the age of three if the foot continues to dynamically turn in. It involves moving a tendon from the inside of the foot to the middle so the child can pull the foot straight up. This is the most common surgical procedure performed for club foot.
Posterior Release (Strayer Procedure)
Infrequently, the Achilles tendon may remain very tight even after treatment which prevents the ankle from moving up so the muscle has to be lengthened and/or the joint loosened.
Osteotomy
In rare cases, the clubfoot may grow banana shaped which requires the cuneiform, cuboid, and/or calcaneus bones to be broken so that the foot can be straightened.
Clubfoot (Congenital Talipes Equinovarus) from David S. Feldman, MD
