Foot Deformities Approach


 

CALCANEOVALGUS FOOT

Many cases of calcaneovalgus foot will resolve over time with no intervention. However, the condition can be resolved more quickly with simple at-home foot stretching exercises. Moderate cases that do not respond to exercises can be treated with splinting and/or shoes that prevent the foot from flexing upwards. Severe cases may require serial casting to hold and slowly manipulate the foot into proper position.


CLUB FOOT

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.)


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.


CONGENITAL VERTICAL TALUS

It is important to diagnose and begin treatment for congenital vertical talus as early as possible to achieve better results. Casting to manipulate and stretch the foot is the first step in treatment. To complete correction of the deformity, surgery is performed (typically before the age of two) to move the dislocated bones of the foot into proper position and locate the joint between the talus and navicular bones. A tendon release may also be performed if the Achilles tendon has become contracted. Older children may require more complex procedures such as fusion of the talus to the heel bone.


FLAT FOOT (PES PLANUS)

Flat feet that do not cause pain or affect a child’s ability to walk or participate in other activities do not require treatment. Pain and discomfort caused by flat feet can usually be relieved with an arch support and foot exercises. Rigid flat feet or pain that is not resolved with conservative treatment may require surgical reconstruction of the foot.


HIGH ARCH (CAVUS FOOT)

A high arch that is flexible does not require any treatment. In cases where there is pain, shoe modifications such as an arch insert or support insole can help to relieve pain while walking. Custom orthotic devices can be made to fit into shoes and provide stability and cushioning. Surgery to decrease the arch or flatten the foot is only considered for very severe cases.


TARSAL COALITION

Most children with metatarsus adductus will naturally improve over time without any intervention. Stretching exercises, splinting, bracing, and/or series casting may be required in cases where the foot is fairly rigid and fails to improve independently. Surgery is only considered in rare cases where the condition persists past age four or five and all other treatment methods have proved insufficient.

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David S. Feldman, MD
901 45th Street, Kimmel Building
West Palm Beach, FL 33407
Phone: 561-264-2141
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561-264-2141