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(877) FOOT 911 Advocating Non-Surgical Treatment for Clubfoot  |
According to research by the University of Aberdeen and Bournemouth University, parents of babies born with clubfoot share many of the negative feelings and perceptions experienced by parents of children with more disabling conditions.
Not too long ago, radical foot surgery was the only and normal treatment for clubfoot. Fortunately, clubfoot treatments advanced with less invasive procedures and more successful results. Here are just a few of those advanced clubfoot treatments.
Clubfoot is a condition that affects about 200,000 infants a year. Babies with this birth defect have one or both feet are turned inward and down, forcing them to walk clumsily on the sides of their feet.
The Ponseti Method, developed by Dr. Ponseti in the 1950s, uses gentle physical manipulation to fix clubfoot.
(picture by nytimes.com)
In each step of the Ponseti Method, a child’s clubfoot is stretched and turned slightly outward, then a hip-to-foot plaster cast is applied. After about five weeks of manipulations and castings, the foot is remolded, then the child wears a brace for a few years.
In 2006, three years before the doctor’s death at age 95, the Ponseti International Association was created at the University of Iowa, where Dr. Ponseti had practiced. Its mission is simple — to train doctors and health care workers in the Ponseti method.
In recent years, the Ponseti International Association has received only about $350,000 annually, far less than most medical charities. Dr. Ponseti, while he was alive, was more interested in research than promoting his work. That role has fallen to his protégé, Dr. Jose Morcuende, who is now the chief medical officer of the Ponseti International Association.
Dr. Morcuende said the organization’s program was growing. Discussions are under way to start a training program throughout Mexico, and similar efforts have started or are about to start in the Philippines, Romania and India.
The organization’s vision, Dr. Morcuende explained, is to create a cadre of trained doctors and health care workers in every country, a permanent medical infrastructure to treat the 200,000 new cases of clubfoot that will occur every year.
“We need about 4,000 to 5,000 good, well-trained people,” he said. Currently, that group stands about 1,500 strong and he estimates that it will take seven to 10 years and about $20 million to bring it to full force.
Some children with clubfoot will continue to require surgery. But Dr. Morcuende said studies have indicated that the Ponseti Method works in up to 98 percent of cases, though it needs to be performed precisely and followed up rigorously to prevent a relapse.
By medical standards, such success is impressive and some of Dr. Ponseti’s disciples have found that the technique has been used on older children, including some who were teenagers. If you would like to contribute to the Ponseti International Association, please go to this link.
If your child has clubfoot, or you suspect that he or she has clubfoot, then you need to seek out a qualified clubfoot doctor who is trained in the Ponseti Method of clubfoot correction. Contact our clubfoot doctors at the Clubfoot Institute by calling (877) FOOT-911. We are here to help you and your child.
If your child or baby is diagnosed with clubfoot, then he or she should begin clubfoot treatment immediately, preferably within the first week of life.
Clubfoot treatment using the Ponseti Method includes manipulation of the foot and then casting to maintain the correction.
(Picture: Clubfoot.About.Com)
Clubfoot casts are changed at weekly intervals (in order to take advantage of a young tissue’s ability to stretch quickly). The foot is stretched and another cast is applied.
Before applying the last plaster cast, which is to be worn for three weeks, the Achilles tendon is often cut in an office procedure to complete the correction of the foot. After the last cast is removed, the foot should appear over-corrected. Most clubfeet are fixed via casting in two months to three months.
One of the questions parents may ask is who should remove the clubfoot casts? Should it be the clubfoot doctor or the parent? In the home or in the doctor’s office?
Because the cast should be changed every 5 days (with the exception of the final plaster cast which is to be worn for three weeks if a Tenotomy is performed), it is important that a qualified and experienced clubfoot doctor remove the cast, do the foot manipulation and apply a new cast (to accommodate the new manipulation) on the child or baby’s clubfoot.
If parents remove the cast at home, they may not do it correctly. And if they try to reapply the cast, they may not do that correctly either. Plus, the corrected position of the foot may be lost. Also, babies are growing so fast that casts shouldn’t be left off for any length of time, not even overnight.
As mentioned earlier, a minor medical procedure called a Tenetomy may be needed to be performed towards the end of the clubfoot castings. The Tenetomy should be followed by the all-important final clubfoot casting.
Fiberglass casts can easily be removed without tools in the doctor’s office, while a plaster cast can be soaked off in water or removed with a cast saw. Either way, the cast removal should been done a qualified clubfoot specialist.
If your child has clubfoot, or you suspect that he or she has clubfoot, then you need to seek out a qualified clubfoot doctor who is trained in the Ponseti Method of clubfoot correction. Contact our clubfoot doctors at the Clubfoot Institute by calling (877) FOOT-911. We are here to help you and your child.
After a child or baby with clubfoot has received serial castings via the Ponseti Method, the next step is the maintenance phase, which is wearing a brace to hold the corrected foot in the right position so that there is not a relapse.
(Picture by globalclubfoot.org)
Studies have shown a 90% (or better) success rate when a child or infant wears a brace after their castings. Here are a few different types of braces for clubfoot.
The Dobbs Brace was invented in 2007 by Dr. Matthew B. Dobbs, and has a bar connecting the feet with a release mechanism that allows parents to easily detach and reattach the bar to place the child in a car seat or high chair, or change a diaper without removing the entire brace.
The Dobbs Brace also allows children to move their legs independently while wearing the brace. Dobbs said these changes are key to preventing a recurrence of clubfoot: “Just having the flexible bar makes a huge difference in compliance and convenience.”
The Ponseti AFO Brace (also known as the Mitchell brace) has been available since 2005. It’s more expensive than most foot abduction braces, but is said to be more comfortable and easier for the baby to adjust to. Dr Ponseti was involved in the design of the Ponseti AFO/ Mitchell brace and it is especially recommended for children with very small feet or complex clubfoot.
The setup of the bars and shoes is according to Dr. Ponseti’s protocol and should not be altered, unless the clubfoot is complex. It’s essential that the foot is corrected 100% before starting in the shoes, and also that the foot doctor fitting the shoes is competent in the Ponseti method and knows how to set them up correctly.
The Steenbeek Foot Abduction Brace (SFAB) was designed in Uganda by Michiel Steenbeek, and endorsed by Dr, Ponseti, and is an effective low-cost option for developing countries.
If parents have to buy braces at full cost this may put them into severe financial difficulty which may eventually result in them stopping treatment.
However, some programs have found that asking parents for a minimal contribution towards the brace as a deposit can help with adherence and means parents take better care of the brace.
If your child has clubfoot, or you suspect that he or she has clubfoot, then you need to seek out a qualified clubfoot doctor who is trained in the Ponseti Method of clubfoot correction. Contact our clubfoot doctors at the Clubfoot Institute by calling (877) FOOT-911. We are here to help you and your child.
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