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Pediatric care for your  little one

Clubfoot describes a range of foot abnormalities usually present at birth in which your baby’s foot is twisted out of shape or position.

In clubfoot, the tissues connecting the muscles to the bone (tendons) are shorter than usual. Clubfoot is a fairly common birth defect and is usually an isolated problem for an otherwise healthy newborn.

Clubfoot can be mild or severe. If your child has clubfoot, it will make it harder to walk normally, so doctors generally recommend treating it soon after birth.

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  Signs and symptoms of Clubfoot

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If your child has clubfoot, here’s what it might look like

  • The top of the foot is usually twisted downward and inward, increasing the arch and turning the heel inward..

  • The foot may be turned so severely that it actually looks as if it’s upside down.

  • The calf muscles in the affected leg are usually underdeveloped

Causes of clubfoot

The cause of clubfoot is unknown (idiopathic), but it may be a combination of genetics and environmental factors.

An abnormality of the tendons and ligaments in the foot causes an abnormal structure and position of the foot. In some children, bones may also be abnormal in terms of shape, size, or position. There may be a link to maternal smoking during pregnancy.

If the foot is abnormally positioned in the uterus during pregnancy, it may not grow into a normal shape, but this is not usually considered a “true” club foot.

Club foot may, in rare instances, be associated with spinal deformities such as spina bifida or other neuromuscular diseases; however, in these cases, the foot is usually more deformed.


Diagnosing clubfoot

Club foot is diagnosed at birth and may be diagnosed earlier, during pregnancy, or through ultrasound. Although club foot may be diagnosed on the basis of physical examination alone, your doctor may also order X-rays of the foot in order to assess the position of the bones and to determine if there are any abnormalities in the bone.

A complete physical examination is performed to rule out other spinal and muscular diseases.

It is important to remember that although it is a painless condition at birth, club foot can worsen with time If left untreated, the child may begin walking on the outer surface of the foot and the toes.

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Comprehensive treatment of Clubfoot

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Bracing. Even after successful correction with casting, clubfeet have a natural tendency to recur. To ensure that the foot will permanently stay in the correct position, your baby will need to wear a brace ( “boots and bar”) for a few years to keep the foot at the proper angle to maintain the correction.

French method /physical therapy method — This method is  typically directed by a physical therapist who has specialized training and experience  and is done soon after birth . Each day, the baby’s foot must be stretched and manipulated, then taped to maintain the range of motion gained by the manipulation.

After taping, a plastic splint is put on over the tape to maintain the improved range of motion. To prevent recurrence of the clubfoot, the daily regimen of stretching, taping, and splinting must be continued by the family until the child is 2 to 3 years old.

Stretching and casting (Ponseti method). This is the most common treatment for clubfoot. Your doctor will:

Move your baby’s foot into a correct position and then place it in a cast to hold it there, Reposition and recast your baby’s foot once or twice a week for several months, Perform a minor surgical procedure to lengthen the Achilles tendon (percutaneous Achilles tenotomy) toward the end of this proces

After the shape of your baby’s foot is realigned, you’ll need to maintain it by Doing stretching exercises with your baby, Putting your child in special shoes and braces and making sure your child wears the shoes and braces as long as needed

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Surgical treatment of club foot

If your baby’s clubfoot is severe or doesn’t respond to nonsurgical treatments, more invasive surgery may be needed. An orthopedic surgeon can lengthen tendons to help ease the foot into a better position. After surgery, your child will be in a cast for up to two months, and then need to wear a brace for a year or so to prevent the clubfoot from coming back.

Even with treatment, clubfoot may not be totally correctable. But in most cases babies who are treated early grow up to wear ordinary shoes and lead normal, active lives.

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