The goal of treatment is to make a club foot functional, painless, and stable, especially for walking. A pediatric orthopedic surgeon experienced in this condition will normally be the best person to treat it. The earlier the treatment starts, the better the results.
Non-surgical treatment includes manipulating the foot into a corrected position and then holding it in position with a cast or splint with tapes. This is usually done 2 to 3 days after birth. The cast is applied from the toes to just above or below the knee and is changed every week until the deformity is adequately improved. Frequent release of the Achilles tendon is needed to completely correct the deformity. Your doctor will make regular assessments of this treatment. In most cases, it is apparent within 6 weeks whether the treatment is successful. An X-ray can also confirm this.
This treatment, if done by a trained doctor, is successful in about 90% of children with club foot. Special footwear or braces may be required to ensure that the muscles do not pull the foot back into the clubbed position. These may be used until the child is 2 or 3 years old.
Surgery may be performed to correct the abnormal tendons, ligaments, and joints. This may also include moving tendons into better positions for the best function. Fortunately, surgery to correct the club foot (excluding the simple release of the Achilles tendon) is quite rare today. The surgery requires a hospital stay of 2 to 3 days. After surgery, a cast is applied to maintain the foot in the corrected position for 10 to 12 weeks. After the cast, a splint is used throughout the day. Once the child starts walking, the use of splint is gradually reduced.
There is no clear consensus regarding when to operate and which surgery to perform. Most orthopedic surgeons prefer to operate when the child is 6 months old, though some prefer to wait until 9 to 12 months of age.
If there are persistent bone abnormalities, surgery may be required when the child is older. An osteotomy (cutting the bone) can be performed when the child is at least 5 years old, or arthrodesis (fusing and stabilizing the bones) may be performed when the child is at least 10 years old. Not all children require more than one operation.
Physiotherapy is always an important part of the treatment. It may begin once the child is 3 months old. The therapist manipulates the affected foot and may also tape it. This alone may be successful in milder cases. Parents can learn these techniques and continue the treatment at home.
Most children do well with treatment when it is started early. If treatment is delayed, non-surgical treatment may be less successful, but it is usually performed. Modern techniques of casting have high success rates even in older children. Some degree of deformity could persist. The foot and the calf on the affected side often remain smaller than normal.
Since the exact cause of club foot is not understood, there is no specific prevention. However, regular monitoring is recommended until the person reaches adulthood. Approximately 20% of affected children experience a recurrence of the club foot, usually in the first 2 to 3 years of life. The recurrence is often more difficult to correct. Your doctor may also advise using corrective shoes and splints until the child matures. But when treatment is started early, most children are able to enjoy full and active lives.
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