Clubfoot: A Very Well-Treated Malformation

What is clubfoot?

Clubfoot is a congenital skeletal deformity affecting the sole of the foot, more specifically the outer part. This part tends to turn towards the middle of the body, creating an inward twisting of the foot.

Clubfoot is a disabling condition with negative impacts extending far beyond the ankle and foot.

A major cause of clubfoot is the genetic factor, explaining the absence of particular symptoms as it manifests from birth. The main characteristic is a foot that is shorter and slightly wider than a standard foot.

The exact causes of clubfoot aren't fully understood. However, genetic, neurological, and muscular factors may be involved in its onset during fetal life.

In some cases, clubfoot is linked to serious disorders such as:

• Spina bifida;
• Cerebral palsy;
• Muscular dystrophy;
• Arthrogryposis;
• Congenital hip dysplasia;

However, clubfoot can also be idiopathic (without a known cause). It has a hereditary predisposition and appears frequently in families with a history of congenital malformations. Clubfoot is often bilateral and more common in males.

Clubfoot: Straightening a Baby's Foot

Different therapies exist for child clubfoot, including:

1. The Ponseti method: Developed in the 1970s, it uses corrective casts worn until the child can walk, correcting the foot as it grows. However, it may not fully correct the problem. A potential issue is bone crushing during casting. Upon cast removal, the foot may appear normal, but internal bone and joint structures may be crushed and deformed;
2. The Codivilla method: This surgical intervention, performed within the first six months of life, permanently corrects the foot using two incisions to stretch tendons and muscles;

Clubfoot: Intensive Rehabilitation

Effective limb function requires tailored treatment. Post-operative rehabilitation is crucial, including:

• Adapted orthotics and orthopedic appliances;
• Maintenance physiotherapy;
• Targeted movement and stretching exercises;

Maintaining the treated area is essential for optimal results. While clubfoot is complex, it's treatable with definitive solutions. Children with clubfoot have a high chance of recovery and normal walking after surgery. Therefore, consulting competent professionals is vital.

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Clubfoot: When is surgery necessary?

Effective clubfoot treatment involves multiple specialists for a comprehensive approach. This often includes a physiatrist, neurologist, podiatrist, and foot surgeon.

The physiotherapist analyzes foot function and mobility. The neurologist assesses the disease's origin and nature, prescribing medication. The podiatrist manages orthoses, and the surgeon assesses the need for skeletal correction. Their collaboration ensures the best and quickest resolution.

However, corrective surgery is the most rational, professional, definitive, and curative solution for clubfoot.

Physiotherapy is mainly useful post-surgery. It doesn't improve the condition; at best, it prevents worsening, but the condition generally worsens with age.

Clubfoot: Exercises to Prevent Recurrence

Physiotherapy and stretching don't correct clubfoot but maintain correction achieved by other treatments. If your child's foot remains twisted after casting and physiotherapy is recommended, consult your doctor.

Here are two exercises to prevent recurrence:

• Dorsiflexion stretch with knee extension: One hand dorsiflexes the foot; the other extends the knee. Perform for two minutes before applying the splint;
• Posterior tibial stretch: Squatting with heels on the ground stretches the posterior tibial muscle. Perform for two minutes daily (parents can assist young children);