If left untreated, the clubfoot patient will not be able to set their foot flat on the ground. This will lead to them being unable to wear shoes or walk without pain. They will often be forced to hobble around on the very outsides of their feet or even their ankles. Because of their inability to move around regularly, many of the people affected have a very low quality of life and miss out on important opportunities.
For people who live in third world countries, the condition can be especially debilitating. In fact, over 80% of cases of untreated clubfoot worldwide occur in third world countries where people do not have access to quality medical care. This can lead to them being ostracized, shunned, and put out on the streets. Many people are unable to perform the tasks required for available jobs, leaving them unemployed and dependent on family or strangers to care for them.
It’s best to start treatment at around 1 to 2 weeks because ligaments, bones, and joints are very flexible and easier to treat. The standard method of treatment for infants and children is called the Ponseti method, which was discussed in an earlier blog post. However, those who did not receive treatment as a child or have experienced a relapse as an adult are generally treated using the Ilizarov method.
According to the Clubfoot Institute in Arcadia, CA, "In the Ilizarov method, wires are placed through bone of the clubfoot and attached to an external fixator, which is slowly adjusted at home by the patient after receiving instructions from the doctor." The fixator then works similarly to braces on teeth-it is gradually tightened, which manipulates the positioning of the lower leg and foot. Unfortunately, this process is very time consuming and painful for the patient. Additionally, since they are older and their bones and ligaments are more mature than a child’s, they may experience a relapse in the condition and be required to repeat the procedure.
-Boston Children's Hospital. Clubfoot in Children. 1 January 2017. Website. 3 April 2017.
-March of Dimes. Clubfoot. 1 January 2013. website. 3 April 2017.
-Mayo Clinic Staff. Clubfoot: Symptoms & Causes. 23 March 2016. Website. 3 April 2017.
March of Dimes. Clubfoot. 1 January 2013. website. 3 April 2017.
Mayo Clinic Staff. Clubfoot: Symptoms & Causes. 23 March 2016. Website. 3 April 2017.
There are several different methods, both surgical and nonsurgical, that doctors use to treat clubfoot. The most common is serial casting and stretching of the tendons and ligaments in the foot and ankle region, more famously known as the Ponseti method.
Using the Ponseti method, doctors will stretch the foot of the patient and cast it in that position for a time span of one to two weeks. At that time, the cast will be removed and the foot will be stretched further, then recasted. The doctor will perform this same process several times until the feet have reached the proper position. After the patient has completed the serial casting, many of them will need to have an Achilles tenotomy performed. During this procedure, the doctor cuts a portion of the Achilles tendon in order to lengthen the ligament and change the position of the foot.
After the patient has been through serial casting and the tenotomy procedure, the doctor will provide them with braces to hold their feet in the proper position. These must be worn for several hours each day in order to prevent the feet from moving back to their natural inward position. Children who are not made to wear their braces often experience a relapse and then are forced to go through more rounds of serial castings, and possibly another Achilles tenotomy.
Clubfoot is a congenital (meaning present at birth) defect that affects the placement of the afflicted person's feet. It can present itself in a range of severity, from feet that simply point inward, to feet that have the bottom pointing upward. It can present itself in one or both feet; up to 50% of infants who have been diagnosed have bilateral clubfoot, meaning both feet are affected. Clubfoot itself is painless to infants who are born with it, but it is important for them to receive treatment right away to avoid future problems. The majority of people who have their condition treated as infants will have no adverse affects later in life.
Occasionally, clubfoot can be caused by the way a baby is positioned in its mother's womb. For example, if there is not enough amniotic fluid, the baby will need to squeeze into a smaller space than normal. However, the majority of children who have clubfoot get it as a result of a genetic anomaly. If one child in a family is born with clubfoot, the other children are more likely to also have the condition. Additionally, some people develop clubfoot in tandem with other medical conditions such as spina bifida or other nerve, muscle, or brain abnormalities. For this reason, children with clubfoot will need to undergo a medical evaluation as soon as the condition is discovered.
In the United States, approximately 1 in 1,000 children are born with clubfoot. Globally, 150,000 to 200,000 babies are born each year with the condition. Approximately 80% of these cases occur in low to middle income areas of the world, meaning that treatment is difficult for these families to attain.
If the condition is not treated, the affected person will not develop the ability to walk and is likely to experience a life of pain and disability. This is why I believe it is extremely important for all people to have access to afforable, quality medical care. If the condition is treated while the patient is young, many medical complications can be avoided. Babies and young children are also far more resilient than adults, which makes the condition easier and more painless to treat them.