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Idiopathic clubfoot is one of the most common musculoskeletal deformities in children. The incidence is 1-2 per 1000 children and in 40% of cases it affects both feet.

What does a clubfoot foot look like?

The foot is bean-shaped. It is twisted inwards and downwards and is very stiff.

What causes clubfoot?

It is not known what causes clubfoot. Genetic factors are likely involved, as there is a predisposition to it being observed in family members. Idiopathic clubfoot is observed in otherwise healthy children. Clubfoot is rarely a manifestation of a syndrome or neurological condition such as myelomeningocele.

How is clubfoot diagnosed?

The diagnosis can be made during a prenatal ultrasound, usually around the 20th week of pregnancy.

Sometimes a foot deformity seen on a prenatal ultrasound is nothing more than a harmless clubfoot ex situ. In babies born with a foot deformity “ex situ” (small space in the uterus or multiple gestation), the foot is flexible. This deformity corrects itself and does not require treatment.

The diagnosis of idiopathic clubfoot is made when the specialized Pediatric Orthopedic examines the baby at birth and finds that the foot is stiff. This condition requires treatment.

What is the treatment for clubfoot?

Fortunately, there is a very effective treatment called the Ponseti Method and it is the method of choice. The treatment is named after Ignacio Ponseti who developed and applied the technique many years ago at the University of Iowa, US. The Ponseti Method includes 2 phases, the correction phase and the correction maintenance phase.

Phases of the Ponseti Method

• The 1st phase is that of applying successive corrective casts. It begins in the 1st to 3rd week of life. The technique of applying special corrective casts requires precision and must be applied by a Pediatric Orthopedic who is certified in the Ponseti method. The casts are changed every week until all elements of the foot deformity are corrected with the exception of the correction of the short Achilles tendon. Usually the 1st phase requires an average of 5-7 casts. This is followed by a minor procedure, the percutaneous lengthening of the Achilles tendon, which is required in 90% of cases. The minor procedure is performed under local anesthesia in the doctor’s office. This is followed by the application of the last cast, which is maintained for 3 weeks.
• The 2nd phase is that of maintaining the correction with the application of a special brace. It is long-term with the application of the brace (bar with shoes) for 23 hours in the first 3 months and then 12-14 hours until the age of 4-5 years. This phase is demanding since it requires full compliance with the rules for applying the brace.

What is the progression?

Children born with Idiopathic Clubfoot and treated with the Ponseti Method by a Specialized Pediatric Orthopedic Certified in the Ponseti Method and who apply the full program for applying the brace are expected to have excellent results. The foot is normal in appearance, perfectly functional and strong. They are expected to wear shoes like their peers, participate in any sports activity and have a normal, happy and productive life.

A small percentage of children with idiopathic clubfoot may experience a recurrence of the condition. The most common cause is early discontinuation of the brace.