Club Foot Management

Clubfoot (also known as Talipes Equinovarus deformity) is one of the most common correctable developmental deformities that reportedly affects approximately 150,000 – 200,000 babies worldwide each year (Ponseti International, 2017).Clubfoot can affect one or both feet and is considered a developmental deformity, as foetuses that develop club foot always start with a normal foot. When clubfoot occurs, the foot begins to turn inward and down, and this condition often develops during the second trimester of pregnancy (Ponseti International, 2017 & Clubfoot: Ponseti Management, 2005).In the majority of cases, babies who are born with clubfoot have all their muscles, bones and connective tissues intact.

The Ponseti treatment is an internationally recognised treatment method that was developed by Dr. Ignacio Ponseti over 50 years ago and has a reported 95% success rate in treating clubfeet. It is also considered the most cost effective treatment method with no side effects (Ponseti International, 2017).
Here in Australia,the majority of babies who are born with clubfoot/feet undergo the Ponseti management, whereby their effected foot/feet are corrected during the first six to eight weeks of infancy through the implementation of gentle manipulation and a series of plaster casts. It is during these first six to eight weeks where the displaced bones are gradually brought into the correct foot and ankle alignment.
Once correction has been achieved,a strict splinting (Boots and Bars) regime is then implemented that would often last until the child is aged 4-5 years old (dependent on their managing physician). This stage of management is crucial in order to prevent any relapse of the clubfoot/feet deformity from occurring.
It is important to note that only a small percentage (<5%) of infants are born with severely affected clubfoot/feet. In these cases of severe or atypical clubfoot/feet, patients would sometimes require special treatment which may involve corrective surgery. The results of these surgical procedures are often favourable when performed by highly skilled orthopaedic surgeons.
NOTE:Treatment of clubfoot/feet should always begin in the first week or two of the infant’s life in order to take maximum advantage of the favourable elasticity of the connective tissues that form the ligaments, joint capsules and tendons in the child’s foot (Ponseti International, 2017).

Ponseti boots and bars are special high top, open-toed boots (Ponseti AFO) that attaches to an adjustable bar which is set at 60-70 degrees of external rotation for the effected side. In children with only one clubfoot, the boot for the normal foot is typically set on the bar at 40 degrees of external rotation.
Boots and bars are used as part of the Ponseti treatment protocol for clubfoot/feet in order to hold and maintain the child’s foot and ankle in the corrected position and to prevent their muscles and ligaments from tightening again (preventing relapse) after the foot has been corrected.
The rate of relapse increases without boots and bars or if the boots and bars are not used according to the Ponseti treatment protocol for clubfoot/feet.
NOTE:boots and bars should only be used after a child’s clubfoot/feet have been completely corrected by manipulation, serial casting and possibly a heel cord tenotomy (Ponseti International, 2017). Use of the brace will not cause developmental delays for the child (Ponseti International, 2017).

The following schedule is based on the Ponseti Protocol:
•   23 hours for the first 3 months (boots and bars can only be removed for baths and changing of clothes). At Massons Healthcare, we recommend that parents use the remaining 1-hour of the day wisely. Our suggestion would be to use approximately 30 minutes for baths and changing and then spread out the remaining 30 minutes into 5-10 minute blocks which you can utilize for skin checks or regular sock changes.
•   After the first 3 months, boots and bars are then only worn for sleeping at night and naps. This treatment period is usually up to the age of four or five years. Please check with your managing orthopaedic surgeon if there are any changes to your child’s treatment protocol.

Here at ORTHOTICS AUSTRALIA, we have partnered with some of the industry’s best manufacturers in clubfoot related products in order to provide our patients and their families with the best clinical support available to them. Our clinicians are great believers in supplying the best products to our clients and it is through our partnership with MD Orthopaedics and C-Pro Direct that enables us to do so.