To describe the characteristic deformation of the foot, when the foot is turned inward from the longitudinal axis of the lower leg, the term “clubfoot” is used.
Congenital clubfoot belongs to the group of malformations of the extremities and is a combination of various deformations of the foot, usually accompanied by supination of the foot and anomalies of the leg muscles. Two-footed clubfoot occurs in approximately 50 percent of cases. The medical term for the general or “classic” form of clubfoot is Talipes equinovarus. As a rule, congenital pathology is more common in boys than in girls (2: 1 ratio). The causes of the disease are not fully understood.
Along with a birth defect, there is also an acquired form, the so-called neurogenic clubfoot, caused in most cases by a violation of innervation.
The doctor makes the diagnosis of typical foot defects immediately after the birth of the baby. The clubfoot will not bother the child until he learns to stand and walk. However, treatment for clubfoot is prescribed as soon as possible after birth in order to take advantage of the elasticity of the tissues forming the articular bags, ligaments and tendons, and continues sequentially. This is very important in order to achieve optimal results, since an untreated foot will remain curved, which generally affects leg movements, resulting in subsequent arthritic pain.
Children, as a rule, are tried to be treated without surgical intervention, by the conservative method known as Ponseti's treatment of clubfoot (therapeutic massage and plaster dressings).
Most clubfoot can be cured in infancy approximately six to eight weeks after birth. An orthopedic surgeon discusses various treatment options with parents. His suggestions for correcting foot deformity should be based on a clear understanding of the functional anatomy of the foot, the biological responses of muscles, ligaments, and bones.
Ponseti Clubfoot Treatment is a controlled technique developed by Dr. Ignacio Ponseti more than 50 years ago at the University of Iowa (USA) and has proven itself extremely well. The Ponseti technique was introduced in the UK in the late 1990s and popularized nationwide by the National Health Service physiotherapist Steve Wilde. In the 2000s, the method became widely used thanks to Dr. John Herzenberg in the USA and Europe, and thanks to the surgeon of the National Health Service of Great Britain Steve Mannion - in Africa.
Ponseti's treatment of clubfoot is now considered the “gold standard” in most developed countries.
Therapy begins in the first or second week of a child’s life, with a straightening phase, when manipulations with tendons and ligaments of the leg do not cause pain. After each procedure, a plaster cast is applied to maintain the degree of correction achieved. It is applied from toes to the groin, once a week in a new position for five to seven weeks (depending on the severity of clubfoot). During this process, the bones of the foot are gradually aligned.
If after correction no more correction is needed, then in most cases a tenotomy is performed - an operative separation of the calcaneal tendon, which needs to be lengthened, since it is always shortened with clubfoot. Under local anesthesia, it is divided completely across by means of a scalpel. A complete dorsal traction of the foot is achieved. Then, a plaster cast is applied to the foot again for three to four weeks.
After a tenotomy, the stage of fixing correction results using special therapeutic shoes (braces or “Denis Brown tires”) on a metal sliding rail that fixes the feet in a certain position, correcting residual deformation in the ankle, begins. After three to four months, wearing the braces can be reduced to fifteen hours a day, in the future they can only be used during a night's sleep. They wear braces for up to two to four years in order to avoid relapse of clubfoot.
Almost 150,000 children are born annually in the world with clubfoot. Ponseti's treatment of clubfoot is painless, successful in almost 100 percent of all cases of congenital pathology, and saves on expensive equipment.