A pediatric orthopaedic surgeon helps put families at ease about this diagnosis.
About 1 or 2 babies out of 1,000 are born with clubfoot, according to the American Academy of Pediatrics. More than 2,000 babies with clubfoot are born annually in the United States and about 200,000 infants per year worldwide.
“Most children with this diagnosis will ultimately do well. They can be very active, run and play sports.”
The diagnosis can be detected on ultrasound during pregnancy. If your baby receives this diagnosis, understandably you may feel concerned. But doctors assure parents and parents-to-be that the condition is treatable, and that after treatment, your child will have a functional and comfortable foot.
“Most children with this diagnosis will ultimately do well,” said Dr. Jeff Martus, a pediatric orthopedic surgeon at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “They can be very active, run and play sports. There are professional athletes who were treated for clubfoot when they were young, including Mia Hamm and Troy Aikman.”
What is clubfoot?
Clubfoot is a congenital foot deformity where the foot is contracted and rotated inward at birth. “Clubfoot is problematic if untreated because patients will end up walking on the top of their foot,” Martus said. “This leads to long-term issues from the abnormal foot shape including pain, skin irritation and problems with shoe fit.”
Treatment for clubfoot
Pediatric orthopedic surgeons have developed an effective treatment. “The Ponseti method is the worldwide standard of care for clubfoot in infants and older patients,” he explained. The treatment includes serial casting, Achilles tenotomy and bracing. The Ponseti method is ideally started in the first few weeks of life but can be started at older ages.
The treatment includes serial casting, Achilles tenotomy and bracing. The Ponseti method is ideally started in the first few weeks of life but can be started at older ages.
With serial casting, casts are applied weekly to gently stretch the foot. After the casting, about 90% of patients will require an Achilles tenotomy procedure to ensure proper range of motion in the Achilles tendon. Martus said, “With the Ponseti method, an Achilles tenotomy is usually done in the first two to three months of life after the serial casting has improved the foot deformity,” he added. “The tenotomy allows the foot to achieve a position flat to the ground.”
Following the tenotomy, the foot is casted for three weeks to allow the tendon to heal in a longer position. When the cast comes off, the child is transitioned into a brace to maintain correct foot position and the foot from reverting to its previous position.
A more soothing experience
Vanderbilt is currently working on a study that is centered around the comfort of babies through the entire treatment process. “We are focused on a comfortable experience, trying to minimize irritating stimulation and creating a baby-friendly environment,” Martus said. “We dim the lights and the baby lies on a vibrating mat during the casting. Our Child Life specialists learn what is most calming for the individual child in terms of music, swaddling, rocking and other soothing techniques to minimize stress during the treatment.”
“We are focused on a comfortable experience, trying to minimize irritating stimulation and creating a baby-friendly environment.”
Martus explained that the research has expanded to find the best way to prevent pain during the Achilles tenotomy procedure, with a study comparing different options to numb the heel. One option involves using a numbing medication that is applied topically and then is absorbed. The other uses a needle-free injector called a J-Tip to push numbing medication through the skin without a poke. While the J-Tip has been used to provide local anesthesia for other procedures, the device hasn’t previously been studied for clubfoot.
What parents should expect about clubfoot treatment
The early treatment does require frequent visits with your child’s care team. “But once we get through the early phase of casting and the procedure, the visits become less often,” Martus said.
The overall goal of treatment, he added, is to ensure that the child has feet that are flat to the ground and very functional. “Despite the diagnosis, most children with clubfoot will do great.”
Specialized orthopedic care for children
The Pediatric Orthopaedics program at Monroe Carell Jr. Children’s Hospital at Vanderbilt offers the region’s most advanced care for a wide range of issues, including complex fractures; sports injuries; deformities of the spine, bones, hips or feet; scoliosis; and infections of the musculoskeletal system.
