Clubfoot is an abnormality in which infant’s foot is turned in an inward direction, quite often so sorely that the base of child’s foot faces sideways or even upwards. Around the world, nearly 120,000 – 200,000 babies with clubfoot are born every year. Clubfoot is not distressful during infancy. However, if infant’s clubfoot is not treated earlier, the foot will stand scarred & they will not be able to walk in a normal way when they grow up. However, with proper & convenient treatment, majority of children can enjoy extensive range of physical activities with slight trace of damage. Most cases of clubfoot can be successfully evaluated & treated with non-surgical techniques that may carry a combination of casting, stretching & bracing procedures.
What is Clubfoot?
Pediatric clubfoot is a congenital disorder that causes the baby’s foot to turn severely in a way that the sole is pointing inwards with the toes pointing down. Although clubfoot is not generally painful it will lead to a permanent deformity that affects the child’s ability to walk. An estimated 1 in 1,000 children are known to suffer from clubfoot, making it one of the most common pediatric congenital musculoskeletal disorders. It is necessary to begin treatment of clubfoot as soon as possible to increase chances of successful treatment & correction.
Research has proven to be inconclusive regarding the exact cause of development of clubfoot in children, however, many pediatric doctors & experts believe that a combination of environmental & genetic factors plays a major role in development of this disorder. Clubfoot causes tendons of the feet, that connect the foot to leg muscles to become tight & shorten is size, which causes the foot to twist inward. Feet are mostly affected in children with clubfoot & boys are found to be at twice the risk of developing clubfoot as compared to girls.
To decide whether a baby is having clubfoot, the following signs & symptoms should be looked for.
- Twisted Foot – Top of the foot is commonly twisted inward & downward, expanding the arch & curving the heel inward.
- Appearance – Foot may be bent so harshly that it genuinely seems as if it is upside down.
- Underdeveloped Calf Muscles – Calf muscles in the concerned leg are mostly underdeveloped.
- Foot Length – Impaired foot may be up to half an inch (nearly 1 centimeter) smaller than the other foot.
Despite the view, clubfoot, however, does not cause any pain or discomfort. It is more likely that surgeons will observe clubfoot soon after the baby is born, based upon presence. Surgeons can point out the most proper treatment or refer the baby to a doctor who specializes in muscle & bone issues (pediatric orthopedist).
Clubfoot conditions can be from mild to severe & appearance is mostly similar in all the cases. The foot is generally turned inward with the sole of foot facing inward & toes are pointed downwards with a deep crease at the bottom of the foot. Affected leg will also be shorter than normal with thinner calves due to undeveloped muscles & these signs are more prominent in children with clubfoot in one foot. Following are the two types of clubfoot.
- Idiopathic (Isolated) Clubfoot – This is the more common type of clubfoot & occurs as a sole condition with no other related medical problems.
- Non-Isolated Clubfoot – This is a more rare form of clubfoot & is seen due to combination of various other health conditions, mostly neuromuscular disorders such as spina bifida & arthrogryposis. In case clubfoot is a non-isolated type condition, non-surgical treatment are required to correct it & is more extensive or require multiple surgeries for effective treatment.
Non-Surgical Treatments for Clubfoot
Main non-surgical methods for treating clubfoot in children are listed below.
This is the most common & widely used technique to treat pediatric clubfoot & includes steady stretching & casting to eventually correct the deformity. Ideally, this treatment needs to begin soon after birth to get best results. Ponseti method includes the following steps.
- Manipulation & Casting – Pediatricians will gently stretch the baby’s foot & manipulate it into the correct position & stabilize it in this position with leg cast that covers the baby’s leg from toes to thigh. Pediatricians will repeat this procedure weekly until the foot shows significant improvement. This procedure requires to be usually performed for 6 – 8 weeks of time to show considerable improvement in position of the deformed foot.
- Achilles Tenotomy – After manipulation & casting procedure is over most babies require minor surgery to release tightness in the heel cord (also known as Achilles tendon). In tenotomy procedure, the doctor uses a thin instrument to cut the tendon through a minute incision. Tendons heal naturally within around 3 weeks & doctors will put the baby’s foot in a cast to promote faster healing through stabilization of foot & ankle. The cast will be eventually removed once Achilles tendon has re-grown to proper & longer length & the previously deformed foot is now in a normal position.
There is a chance that clubfoot in the baby might recur even after correction using manipulation & casting. Doctors, for this reason, will suggest putting the baby’s feet in a brace called ‘boots & bar’ for a few years to ensure that feet remain in the corrected position.
French method is another type of non-surgical treatment for correcting clubfoot & is also known as ‘physical therapy’ or ‘functional’ method. It involves stretching, mobilization & taping. This procedure is performed by a physical therapist with specialized training & experience. French method needs to be initiated soon after birth to be more successful & requires participation of the family as well. A physical therapist will perform stretching & manipulation to the deformed foot & then tape it in a stretched position. Plastic splint is put over the tape to retain the improved motion range. This method shows significant improvement in baby’s foot position within the first three months & might require Achilles tenotomy to maintain the restored mobility of foot.
Most generally, doctors identify clubfoot soon after birth just from looking at the shape & positioning of the infant’s foot. Sometimes, doctors may ask for x-rays to understand how severe the clubfoot condition is, but usually, x-rays are not required.
- Ultrasound – It can identify clubfoot while a baby is still in the womb. It is more common for surgeons to diagnose this condition after a baby is born, though, based upon the characteristics & mobility of the legs & feet. In certain cases, particularly if clubfoot is due just to the location of the growing baby (often known as postural clubfoot), the foot is bendable & can be moved into a regular or nearly normal position after birth of baby. In other cases, the leg or foot is more stiff or rigid & the muscles at the backside of calf are extremely tight.
- X-Ray Tests – It may not be helpful to confirm diagnosis. Some of the infant’s ankle & foot bones are not fully hardened & do not show appropriately on x-rays.
When someone’s baby is born with clubfoot, he/she will be diagnosed soon after birth. In several cases, infant’s doctor may refer parents to a pediatric orthopedist. If parents have time before initial meeting with the child’s doctor, they should make a list of queries regarding clubfoot. Time with the doctor may be restricted, so it helps to be prepared. Following are some questions to consider asking surgeons.
- Do you generally treat newborn babies with clubfoot?
- Should my baby be mentioned to a specialist?
- What kind of therapeutic treatments are available?
- Will my baby need clubfoot surgery?
- What type of follow-up care will my baby require?
- Should I get a second opinion prior to my baby’s treatment?
- After completion of clubfoot treatment, will my baby be able to walk properly?
- Are there any relevant materials that I can read to understand the procedure?
- What websites do you suggest I refer to?
In addition to these questions, patients should tell doctors regarding family members who have had clubfoot in the past.
Most cases of congenital clubfoot can be treated with non-surgical (Ponseti & French) methods if started soon after baby’s birth. Certain severe cases of clubfoot require a surgical approach as deformity can recur or severity makes non-surgical methods unsuccessful. Surgical methods are required to adjust joints, ligaments & tendons in foot & ankle to correct severely deformed foot caused by clubfoot disorder in children. There are two main types of surgical methods that are applied for treatment.
- Less Extensive Surgery – This surgery will aim to release only those tendons and joints that are causing the deformity. Mostly this will require releasing the Achilles tendon behind the ankle or a ‘tendon transfer’ which involves shifting the tendon which is situated at the front of the ankle to the inner side of the mid-foot. This ‘tendon transfer’ procedure is also called an anterior tibial tendon transfer.
- Reconstructive Surgery – Major reconstructive surgery for clubfoot requires an extensive release of a number of soft tissue structures of the foot. Once the desired correction is achieved the joints in the foot are stabilized with help of pins & leg casts (from toes to thigh) will be put on the operated leg to help promote healing of soft tissue. Doctors will usually remove the leg cast & pins after about 4 – 6 weeks of time & put a short-leg cast for the next 4 weeks. In order to avoid recurring of clubfoot, doctors will advise putting special brace or shoes for at least a year after surgery.
Babies normally stay in hospital for two days after clubfoot repair surgery. Foot is casted & kept inflated with application of cold ice packs to minimize pain & swelling. Painkillers & medications may also be prescribed to alleviate pain. During initial two days following clubfoot surgery, the skin near toes & casts are evaluated carefully to make sure that proper blood circulation, movement & feeling are maintained. Cast is generally left on for about three months after the child leaves the hospital. Moderate skin irritations due to the cast or infections may be observed. Physical therapy may be ordered after removal of the cast to keep the ankle & foot in proper position & enhance its elasticity alongside strengthening the muscles in corrected foot. Appropriately treated clubfoot is completely compatible with a regular & active life. Most kids who have undergone clubfoot surgery grow normally & are able to participate wholly in any recreational or athletic activity that they want.
During the surgical procedure, anesthesia may sometimes cause adverse effects. Some of the potential risks from any type of anesthesia are given below.
- Reactions to medications
- Breathing issues
Possible complications from clubfoot surgery are enumerated below.
- Foot swelling
- Damage to nerves in foot
- Wound healing problems
- Problems with blood flow to the foot
Vast number of babies treated with the ponseti treatment method will have normal-looking & pain-free feet that function well. Most infants learn to walk by the normal age & can participate in physical activities such as sports when they are older. Some kids may be left with a marginally smaller leg & foot on a single side if only one of their feet was impaired. Although this will not cause any evident problems, but it may result in slightly less mobility & the child may get tired easily than other children.
Medical Tourism for Best Treatment of Clubfoot
There are several countries across the globe which are fast emerging medical tourism destinations catering to international patients. Many of them are sorted out choices of thousands of healthcare tourists from abroad that come to get efficient & low cost medical treatments for a variety of medical disorders including pediatric orthopedic treatments like clubfoot. These medical tourism destinations have one of the largest networks of internationally accredited global-standard hospitals & clinics that are equipped with the latest & most modern medical & surgical instruments. These multispecialty hospitals are also well-known for providing the best of surgeries & treatments at the lowest cost. Patients can depend upon these healthcare systems to provide proper treatments for their ailments. Some of the major benefits of treating babies in these countries are listed below.
- Medical Provisions – State-of-the-art healthcare & diagnostic provisions.
- Cost-Effective Treatments – Competitive prices for surgical procedures & treatments.
- Language – Highly trained & English-speaking medical professionals.
- High-Quality Treatments – Strict adherence to globally recognized quality healthcare standards.
- Tourism Infrastructure – Economical accommodation & favorable tourism destinations.
Affordable Clubfoot Treatment with Travcure Medical Tourism
Travcure Medical Tourism is one of the top-most healthcare providers across the world. Pediatric orthopedists associated with Travcure are specialists in performing pediatric orthopedic treatments & surgeries on kids of all ages, from an infant to adolescents. Healthcare experts at Travcure offer the best possible orthopedic treatments including surgery for clubfoot for children in countries like Turkey, Germany, United Arab Emirates, South Korea & India. Parents can rely upon seamless services offered by Travcure for giving children the best treatment of clubfoot along with the personalized care of experienced world-class pediatric specialists.
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