Club foot repair, also known as foot tendon release or club foot release, is the surgical repair of a birth defect of the foot and ankle called club foot.
Club foot or talipes equinovarus is the most common birth defect of the lower extremity, characterized by the foot turning both downward and inward. The defect can range from mild to severe and the purpose of club foot repair is to provide the child with a functional foot that looks as normal as possible and that is painless, plantigrade, and flexible. Plantigrade means that the child is able to stand with the sole of the foot on the ground, and not on his heels or the outside of his foot.
In the United States, club foot is a common birth defect, and occurs at a rate of one to four cases per 1,000 live births among whites. Severe forms of clubfoot affect some 5,000 babies (about one in 735) born in the United States each year. Boys are affected with severe forms of clubfoot twice as often as girls. The risk increases 30-fold in individuals who have a relative of the first-degree affected by the defects.
A newborn baby's club foot is first treated with applying a cast because the tendons, ligaments, and bones are quite flexible and easy to reposition. The procedure involves stretching the foot into a more normal position and using a cast to maintain the corrected position. The cast is removed every week or two, so as to stretch the foot gradually into a correct position. Serial casting goes on for approximately three months.
In 30% of cases, manipulation and casting is successful, and the foot can be placed in a brace to maintain the correction. In about 70% of cases, manipulation and castings alone do not correct the deformity completely and a decision will be made concerning surgery.
The type of surgery depends on how severe the club foot is. The deformity features tight and short tendons around the foot and ankle. Surgery consists of releasing all the tight tendons and ligaments in the posterior (back) and medial (inside) aspects of the foot and repairing them in a lengthened position. Metal pins may also be used to maintain the bones in place for some six weeks. Surgery usually involves an overnight stay in hospital. After surgery, the foot is casted for some three months, followed by the use of a brace to hold the correction. The brace is worn for approximately six to 12 months after surgery.
Presurgical diagnosis requires radiography. The evaluation usually includes only the acquisition of weight-bearing images because the stress involved is reproducible. In babies, weight-bearing is simulated by the application of dorsal flexion stress.
Some surgeons prefer to wait until the child is about one year old before performing surgery, so that the foot may grow a little larger to facilitate surgery. Other surgeons operate as early as three months of age when it becomes clear that further castings will not achieve any more correction.
The patient usually stays in the hospital for two days after club foot repair. The foot is casted and kept elevated, with application of ice packs to reduce swelling and pain. Painkillers may also be prescribed to relieve pain. During the 48 hours following surgery, the skin near the cast and the toes are examined carefully to ensure that blood circulation, movement, and feeling are maintained. After leaving the hospital, the cast is usually left on for about three months. Skin irritations due to the cast or infections may occur. A course of physical therapy may be indicated after removal of the cast to help keep the foot in good position and improve its flexibility and to strengthen the muscles in the repaired foot. The well-treated clubfoot is no handicap and is fully compatible with a normal, active life. Most children who have undergone club foot repair develop normally and participate fully in any athletic or recreational activity that they choose.
The risks involved in club foot repair are the general risks associated with anesthesia and surgery.
If club foot repair is required, the foot usually becomes quite functional after surgery. In some cases, the foot and calf may remain smaller throughout the patient's life.
If left untreated, club foot will result in an abnormal gait, and further deformity may occur on side of the foot due to preferential weight bearing.
Dr. Ignacio Ponseti developed this method which consists of a weekly series of gentle manipulations followed by the application of casts which are placed from the toes to the upper thigh. Five to seven casts are applied every week. Before applying the last cast, which is worn for three weeks, the heel-cord is cut to finalize the correction of the foot. By the time the cast is removed the heel-cord has healed. After this two-month period of casting, a splint is worn full-time by the patient for a few months and is then worn only at night for two to four years. Special shoes also maintain the foot in the corrected position.
This method consists of daily physical therapy, featuring gentle and painless stretching of the foot. The foot is then taped to maintain the corrected position until just the next day's visit. At night, the taped foot is inserted into a continuous passive motion machine at home to maximize the amount of stretching. The tape is removed for a few hours each day to wash the foot, air the skin, and to perform exercises. Removable splints are also used to support the taped foot. The one-hour physical therapy sessions are conducted five days each week for approximately three months. Taping is stopped when the child starts walking.
Lehman, W. B. The Clubfoot. Philadelphia: Lippincott, Williams and Wilikins, 1980.
Ponseti, I. V. Congenital Clubfoot. Fundamentals of Treatment. Oxford: Oxford University Press, 1996.
Simons, G. W. The Clubfoot: The Present and a View of the Future New York: Springer Verlag, 1994.
Aronson, J. and C. L. Puskarich. "Deformity and Disability from Treated Clubfoot." Journal of Pediatrics and Orthopedics 10 (1990): 109–112.
Cooper, D. M. and F. R. Dietz. "Treatment of Idiopathic Clubfoot. A Thirty Year Follow-up." Journal of Bone and Joint Surgery 77A (1995): 1477–1479.
Herzenberg, J. E., C. Radler, and N. Bor. "Ponseti Versus Traditional Methods of Casting for Idiopathic Clubfoot." Journal of Pediatrics and Orthopedics 22 (July-August 2002): 517–521.
Ideka, K. "Conservative Treatment of Idiopathic Clubfoot." Journal of Pediatrics and Orthopedics 12 (March-April 1992): 217–223.
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. http://www.aap.org .
Shrine and Shriner's Hospitals. 2900 Rocky Point Dr., Tampa, FL 33607-1460. (813) 281-0300. http://www.shrinershq.org/index.html
American Academy of Pediatrics. "Club Foot." Essentials of Musculoskeletal Care [cited April 2003]. http://www.aap.org/pubserv/essenexp.htm .
The Club Foot Club [cited April 2003]. http://home.ica.net/~maudefamily .
"Help for Patients with Club Foot." Shrine and Shriners Hospitals. March 28, 2003 [cited April 2003]. http://www.shrinershq.org/patientedu/clubfoot2.html .
"List of Physicians Qualified in the Ponseti Method." Virtual Children's Hospital [cited April 2003]. http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/physicians.html .
"Patient Guide to Club Foot." John Hopkins Department of Orthopedic Surgery [cited April 2003]. <http://www.hopkins medicine.org/orthopedicsurgery/peds/clubfoot_new.htm> .
Monique Laberge, Ph.D.
Club foot repair is performed in a hospital. Club foot surgery is difficult and requires meticulous attention to details. It is accordingly performed by experienced pediatric orthopedic surgeons who are specialists in the field.
Is/are there a series of exercises or stretching movements that we can perform to loosen and/or straighten the foot to where it was after the casting and splints?
Sincerely,
Judy M. Gray
exercises for club foot ,what's its frequency \week?
can we use ultrasonic for club foot ?what " indication?
Thanks a lot
Roberta Lamonica
Mobility I would say I have had a good 90% over the past 31 years, walking 100% though my foot cramps up after 15 miles (I rarely do this distance now). Running 80%, I can only manage 1500m max, then I start to turn to the right as I take shorter and shorter steps. Driving 90% I thought this would be un-affected but after 3H I get cramp. I have noticed my right leg is now visually smaller then my left, my foot was always smaller, this is new.
What I would like to know is if there is any way to correct my foot further now I have stopped growing? Is it possible to move my tendon back to its correct location?
as fit as possible although I did not participate in running sports.I married, had three normal children and now four grandchildren, none of whom were born with club feet. My foot has become quite painful and arthritic for a number of years, with a severe arthritic flare-ups over the past year. Consultation with a rehabilitation specialist in Vancouver, BC recommends immediate bracing and or splints. What are the surgical alternatives if any?
1. Couldn't soft tissue methods still work?
2. What about physical therapy (which was never prescribed for her)
3. What about a brace?
4. Is this surgery 100% effective?
Thanks for your help
I was born with Bilateral Talipes and I am now 30. I assume the technology and methods to repair Club Foot is far greater now than in 1979. I have undergone 7 operations so far since birth and my left rood is still deformed somewhat and affects my self esteem and Gym excercise.
Can I go for reconstructive surgery now to flatten my foot more and make it look more normal? Also I am considering having Calf Muscle implants as my left calf is quite small.
Any ideas and thoughts??
thank u..donna
Our son is now going to turn seven. He just ran four miles the other day and continues to jump, hit baseballs and get into just about everything a normally footed kid of that age does.
so please tell me will my normal height will grow further or not now my age is 18 years n my height is 5foot 5inch.
2.What are the chances that my child's club foot will get corrected?
3.How long will it take to recover from the surgery?
4.What procedures do you follow?
5.How much club foot surgery do you perform each year?
i have about $5000 dollars worth of debt.. After 4 hours of standing my feet start to hurt very bad 10/10 on the pain scale and it last for days. My doctor will not prescribe me pain killers for some odd reason. I can't find an office job, or a job were i don't need to stand. I am becoming very depressed, and I don't know what to do anymore. I've dug my self into such a deep hole, and I can't get out(credit card, school loans, doctor bills, work needed on my vehicle, etc). I need some advice, and I need it now. Why wont my doctor prescribe me painkillers so I can work 8-10 hour days like a normal human-being.. I'm on the verge of giving up, I can't take this bullshit any longer... My family has always been here for me, but we just don't know what to do. Please someone get back to me ASAP!
Thankyou again. Hayley King liverpool uk my email is hayleyking84@live.co.uk
1. What is soft tissue method?
2. Could physical therapy or massage avoid sugery?
3. Is this surgery 100% effective or club feet still can come back?
Thanks for your help
Feet like I have a cast 24 hours I think in dying
Kind regards
Andrea Wright
It can be also solved by using orthofeet Avery Island – Black shoes which reduces your pains and make you feel more comfortable. That’s why people are mostly orthofeet shoes it is not only providing shoes but also reducing the pain caused in legs to the people.