The gold standard for clubfoot treatment can begin soon after birth to help children with long-term motion and function of the foot and leg.

Story by: Kim Huston on December 21, 2020

Clubfoot, sometimes known as club leg, affects roughly 1 out of 1,000 newborns. Clubfoot treatment, including the Ponseti method, can begin soon after birth. Treatment with a pediatric orthopedist can give children with clubfoot the opportunity to have nearly 100% effective correction on their affected feet.

What is clubfoot?

Clubfoot is a condition present at birth that results in a child’s ankle being stuck downward, the foot being turned inward or often pointing toward the other foot and hooked onto itself. In about 50% of cases of clubfoot in children, both feet area affected. Clubfoot can be diagnosed at birth by a thorough physical examination. The condition can be detected in the womb through an ultrasound.

“More often than not, clubfoot is being presumptively diagnosed during routine perinatal ultrasounds,” said James E. Moyer, M.D., nonsurgical pediatric orthopedics physician with Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine. “I offer perinatal consults to expectant parents to go over what treatment could look like for their child. I want to help dispel any misconceptions and ease any fears parents may have about orthopedic care their child will need.”

Ponseti method for clubfoot treatment

The Ponseti casting method is considered the gold standard of care for children with clubfoot. Clubfoot treatment, including Ponseti method and heel cord lengthening, is available at the Norton Children’s Orthopedics of Louisville clubfoot clinic.

“Ideally, clubfoot treatment begins in the first month of life,” Dr. Moyer said. “The Ponseti method involves a series of long leg plaster casts. The casts passively stretch and slowly correct the foot in a stepwise fashion.”

According to Dr. Moyer, the Ponseti method essentially has two main phases, correction and bracing:

• Correction: Casting is typically approximately five to eight weeks. During casting, a child has a cast removed and then reapplied every week. The initial material is a plaster cast to mold the foot optimally. At Norton Children’s Orthopedics of Louisville, this cast is over-wrapped with fiberglass material. Typically, it takes five to eight casts for the foot to be corrected before a procedure called a heel cord tenotomy. This is a minor procedure, during which the Achilles tendon is cut to help lengthen the tendon. This helps release the foot from a stuck-down position. Nearly all children will need a heel cord tenotomy as part of their clubfoot treatment. Following the tenotomy procedure, a final cast is placed. The child goes home in this final cast, and after three weeks, they return to the clinic where the cast is removed. If a child’s foot is corrected as much as it can be, then bracing is started to help keep the correction in place.
• Bracing: This part of treatment helps the foot positon stay corrected after casting. Bracing holds the foot or feet in the correct position. Children will need to be in a brace full time (23 hours per day) for the first three months. Then, a child may graduate to nighttime bracing, with a goal of being in the brace for 12 hours. Bracing is recommended for children with clubfoot until age 4. Bracing lowers the risk that a child’s foot will revert back to its clubfoot position. Without bracing, recurrence of clubfoot in the first year is close to 90%, according to Dr. Moyer.

“Bracing is crucial for children with clubfoot,” Dr. Moyer said. “The biggest challenge for children with clubfeet is maintaining the correction after it has been obtained. But with regular stretching and good compliance with the bracing protocol, the outcomes are, generally speaking, very good.”