What is Clubfoot Casting and Surgery?
Clubfoot also known as talipes equinovarus is a congenital condition characterized by the inward and downward twisting of the feet at the ankles. It is usually diagnosed at birth and is best treated a few weeks after birth. If untreated, it can affect your child’s ability to stand and walk. Clubfoot casting is a non-surgical method employed for the early correction of clubfoot. In cases of severe clubfoot or for older children and adults, surgery is recommended for correction.
Anatomy of Foot and Ankle
The foot and ankle are made up of many bones and joints that help in movement and balance. There are 26 bones and 33 joints in the foot connected by numerous tendons, muscles, and ligaments. In clubfoot, the tendons and ligaments of the foot and ankle are shorter causing the foot to twist out of shape.
Preparation for Clubfoot Casting or Surgery
- Prior to the procedure your doctor will review your child’s medical history
- A physical examination is performed
- Do not stop giving medicines to your child unless instructed by your doctor
Procedure for Clubfoot Casting and Surgery
Casting and surgery are methods to correct clubfoot.
Casting (Ponseti method)
This is a non-surgical method in which your baby’s foot is stretched and placed into a cast so that it gradually corrects to a more normal position. The treatment starts as early as two weeks after your baby’s birth. The process involves two steps:
- Your doctor first gently stretches and moves your baby’s foot to improve its flexibility.
- The leg is then padded from knee to foot with the foot in a slightly corrected position. To help your baby hold still, you may be instructed to feed your baby at this time.
- The plaster cast is then applied to hold the foot in the corrected position.
- After a week in the cast, the foot structure is slightly corrected and the cast will be removed. Your baby’s foot is again stretched and manipulated to further correct its position before applying a new cast.
- This process is continued for several weeks to a few months until your child’s foot is completely corrected.
- Your doctor may sometimes recommend Achilles tendon release surgery (Achilles tenotomy) to help the foot move upwards without restraint. This is performed usually before the last casting procedure. A small incision will be made over the back of the ankle cutting through part of the Achilles tendon to help it lengthen. The incision heals while in the cast.
After the final casting procedure, bracing is performed to help maintain the correction achieved and prevent relapse as your child grows. Continuous bracing is needed for 3 months and later only at night and while napping.
If non-surgical treatment is ineffective, clubfoot is severe or your child is grown, surgery will be recommended.
There are two main procedures performed:
Tendon Transfer Surgery
This procedure is performed under general anaesthesia. A small incision will be made on the inner area of the foot and the affected tendon is exposed and removed. A healthy tendon from another part of the foot is surgically transferred to this region and attached to the bones so that the foot position is corrected and supported.
This is a surgical procedure in which the bones are cut and repositioned to provide proper foot alignment. The repositioned bones are stabilized using pins, plates, or screws. The incision site is then stitched and bandaged. Either orthotics or a cast will be provided after surgery.
Post-operative Care and Recovery for Clubfoot Surgery
- Depending on the extent of the surgery, your child will need to stay in the hospital for 2 or more days.
- Your child’s feet should be kept elevated for up to 48 hours to prevent or control swelling.
- Ice should be applied to reduce swelling and pain.
- You need to check for any discolouration on the toes due to poor blood circulation. Wiggling the toes is recommended to promote circulation.
- Keep the cast clean and dry.
- Inform your doctor in case of any skin infections or rashes.
- Your doctor will recommend physical therapy once the cast is removed.
Risks and Complications of Clubfoot Casting and Surgery
Some of the most common complications of clubfoot casting and surgery include:
- Skin irritation
- Ulcer formation in the cast
- Excision of the peroneal artery during surgery
- Sliding of the cast
- Foot swelling
- Wound bleeding and infection
- Breakage of the cast
- Nerve damage
- Blockage of blood flow