We at SCFAS want you to know that you are not alone, and we are here to help in any way we can. We understand how emotional the treatment process can be. The birth of any baby can trigger a host of emotions, from pure happiness to fear and anxiety. If you have just had a prenatal clubfoot diagnosis or are a parent of a child born with clubfoot, please know that clubfoot is a treatable birth defect, and it is completely normal to feel overwhelmed and scared while thinking about the future. If you plan to or have adopted a child with clubfoot, congratulations! You will be embarking on one of the most amazing experiences in your life by providing your child with a completely different life, starting with the use of their feet! Also know that there is great hope for older children with clubfoot. We also welcome other loved ones and family members! Your family will be experiencing a potentially very challenging but equally rewarding process, and it is important to stay positive and supportive throughout this time. We are always happy to see family members at our appointments to help out or take pictures of the progression. We believe that the single most important thing we can do is provide you all with knowledge and reassurance to help give you confidence. Studies show that informed parents and families will have better outcomes. On the following page you will find information about clubfoot that will hopefully inform and reassure you. We also provide a couple of case reviews which will take you through the casting and bracing process. If you have questions or concerns, feel free to fill out the contact form online, and Dr. Rodriguez will contact you personally. We are conveniently located in Mission Viejo, CA across from Mission Hospital in Orange County. Lastly but most importantly, we want to congratulate you and your family on welcoming your new addition!
Clubfoot is a deformity of the foot and ankle in which the foot turns inward and down, resembling a golf club. The medical term for clubfoot is Congenital Talipes Equinovarus (CTEV). Congenital means it is present at birth. Talipes pertains to the foot and ankle, and Equino refers to the sagittal deformity or the tightness of the heel cord (Achilles tendon), causing the foot to point downward. The Varus refers to the frontal plane deformity in which the heel turns inward. Research shows that the condition develops in the womb around the third month of pregnancy and may be diagnosed on prenatal ultrasound. The condition can be unilateral (affecting only one foot) or bilateral (affecting both feet). The affected foot and calf are generally smaller in size than their unaffected counterparts. Clubfoot is one of the most common congenital deformities, affecting about 1 in 1000 newborns. Clubfoot can be flexible or rigid in nature and can cause significant pain and disability if left untreated. However, in newborns and non ambulating babies, clubfoot is not painful.
Most cases of clubfoot are diagnosed at birth. Some cases are diagnosed through a routine prenatal ultrasound.
The gold standard for treating clubfoot is the Ponseti casting technique, developed by Dr. Ponseti in 1948. This is a method of serial gentle manipulations with application of plaster casts (5-7) above the knee to retain the correction. Weekly manipulations should ideally begin shortly after birth to facilitate the maximum advantage of soft tissue stretching and correct bone alignment. Before the last cast is applied, a minor procedure, Tendo Achilles Lengthening (TAL), is usually performed to lengthen the heel cord (Achilles tendon). The last cast will be worn for 3 weeks, thus allowing the tendon to heal completely. It is of utmost importance that parents be informed and understand that treatment does not end after the last cast. It is absolutely essential that a Foot Abduction Brace (FAB) be worn full-time for the first 3 months, slowly transitioned to only naps and nighttime until the child is 4-5 years old. This is necessary because, following correction, there is a high tendency of relapse, and the FAB is the only successful method for preventing a relapse when used consistently as described. X-rays are usually not necessary except in complicated cases.
A very small percentage of cases of clubfoot may be considered complex in which the foot is short, plump, stiff, and unyielding to stretching. These feet have a deep transverse skin fold above the heel and across the sole of the foot. These cases require special treatment and may need surgical correction. In general, for all cases of clubfoot, long-term studies show that bone and joint surgery should be avoided, since it leads to stiffness, scarring, and muscle weakness which become more apparent and disabling after adolescence.
Recent research shows that the Ponseti method can successfully be applied in children as old as ten. This is the case with neglected clubfoot, recurrent clubfoot, and even recurrent clubfoot in children with failed surgeries. The treatment for clubfoot should start as soon as possible, ideally within the first couple of weeks after birth.
Find out more on how we can come together and help eradicate clubfoot disability worldwide. Learn more about donating Learn more at Ponseti international website Learn more about Miraclefeet World Clubfoot Day California June 4, 2016
Ponseti Clubfoot Casting - Santiago Alamillo
Santiago was a newborn that we started casting when he was a couple of days old. He had a total of 5 casts applied with a TAL done before his last cast that he wore for 3 weeks (making his total treatment time 7 weeks). He went into the Ponseti brace for 24/7 the first 3 months and then slowly transitioned to only wearing the brace while napping and sleeping.
Ponseti Clubfoot Casting in an Older Child - Zane
Zane was a toddler (19 months) with bilateral neglected clubfoot who was adopted from China, where he was treated with a TAL, bracing and no casting. We casted Zane every two weeks for a total of four months (8 casts). He did not require another TAL. After his last cast, Zane had physical therapy and wore the Ponseti brace at night. Because Zane was walking at the time of casting we reinforced the plaster casts with fiberglass casting to avoid breaking down and the need for reapplication.