Clubfoot: Surgery

Why does my child need surgery?

Clubfoot is one of the most frequent and complex deformities in children with cerebral palsy. Clubfoot is a foot whose longitudinal axis forms an angle of more than 90° with the longitudinal axis of the leg (in the position of maximum correction). In other words, the toe of the foot remains pointing downwards and dorsal flexion (upwards) of the ankle is not possible. This will result, when walking, in a modification of posture (which will therefore be done with the toe on the ground) and gait pattern.

This alteration can be present on only one foot (unilateral clubfoot, as is generally the case in hemiparesis) or on both (bilateral clubfoot, with symmetrical or asymmetrical involvement).

If the child's clubfoot is severe or does not respond to conservative treatment, more invasive surgery may be necessary. This involves stretching the tendon, muscle, and joint structures that lock the foot in the deformed position. After surgery, the child will need to wear a cast for a maximum of two months, then wear a brace for about a year to prevent the clubfoot from recurring.

In most cases, early treatment of clubfoot yields good results, allowing the child to lead a perfectly normal and active life without the need for special shoes.

What will the surgeon do?

Depending on the type of clubfoot, the orthopedic surgeon and pediatrician will choose the type of therapeutic approach. The medical team essentially takes into account the following factors:

• The severity of the clubfoot;
• The child's age;
• Any other treatments the child has received;

If a child's foot has been partially corrected by stretching and casts, the surgery needed to fully correct the clubfoot will be less extensive.

Less extensive surgery will focus only on the tendons and joints that contribute to the deformity. In many cases, this involves releasing the Achilles tendon at the back of the ankle or moving the tendon that runs from the front of the ankle to the inside of the midfoot.

Major surgery for clubfoot involves significant release of several soft tissue structures in the foot. Once correction is achieved, the foot's joints are usually stabilized using pins and a long leg cast while the soft tissues heal.

How is the operation performed?

Ligaments are tissues that help hold bones together in the body. Tendons are tissues that attach muscles to bones. Clubfoot occurs when tight tendons and ligaments prevent the foot from stretching into the correct position.

To surgically repair a clubfoot, the surgeon generally makes one or two incisions in the skin, most often at the back of the foot and around the inside of the foot.

The surgeon may choose to lengthen or shorten the tendon around the foot. The Achilles tendon at the back of the foot is almost always cut or lengthened.

In older children or more severe cases, it may be necessary to cut some bones. Sometimes pins, screws, or plates are placed in the foot. All surgical approaches to clubfoot are performed under general anesthesia.

A cast is placed on the foot after surgery to hold it in position during healing. Sometimes a splint is placed first, then the cast is applied a few days later. Older children who still have foot deformity after surgery may need another operation.

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What is the hospitalization like?

Depending on the surgery performed, the child may go home the same day or stay in the hospital for 1 to 3 days immediately after surgery. The hospital stay may be longer if the operation was also performed on the bones. The child's foot should be kept elevated. Medications can help control pain.

The skin around the child's cast will be checked often to make sure it is still pink and healthy. The child's toes will also be checked to make sure they are pink and that the child can wiggle and feel them. These are signs of good circulation.

What can happen when you get home?

The child will wear a cast for 6 to 12 weeks, which may be changed several times. Before the child leaves the hospital, the nursing staff will explain how to care for the cast and splints and how to choose baby clubfoot shoes.

And afterwards?

After recovering from surgery, the child's foot will be in a better position. The child should be able to lead a normal and active life, including playing sports, but their foot may be more stressed than a foot that has not been surgically treated.

And the follow-up?

Post-operative follow-up for clubfoot surgery consists of a series of visits with the clubfoot specialist that should not be missed to check the success of the clubfoot surgery and to ensure that there is no risk of recurrence. During these consultations, parents and the surgeon can check the before and after pictures of the operated child's clubfoot and therefore follow the evolution of the results.

Will there be any sequelae?

In most cases of clubfoot, if only one side is affected, the child's foot and calf will be smaller than normal for the rest of their life. Children who have undergone clubfoot surgery may need another operation later in their life.

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