Orthopaedic Surgery
Treating Clubfoot
Initially, all children are treated non-operatively, no matter how severe their clubfoot may be. This non-operative treatment involves weekly visits to NewYork-Presbyterian Morgan Stanley Children's Hospital or one of our other practice lodations, for manipulation to improve the alignment of the foot, followed by application of a long leg cast to maintain the new alignment. Generally 5 to 8 casts are required to correct the clubfoot. All of the deformities are corrected with the casting except for the hindfoot equinus. This usually requires a percutaneous Achilles tenotomy (cutting of the Achilles tendon).
Following this procedure the child will be placed back into a cast for 3 more weeks. The cast is then removed and boots connected by a bar are used to maintain the correction. This is a very important part of the treatment. The boots and bars are worn full-time for 3-4 months. Following this, they are worn for nights and naps until the child is 3-4 years of age.
In rare instances, non-operative measures fail to correct the deformity effectively, and surgery becomes the recommended treatment. If surgery is going to be performed, the optimal time in a child's life is between 6 and 12 months of age. Studies have suggested that surgery during this time frame will minimize scarring, which can occur with younger children, while maximizing the opportunity for growth and remodeling of the bones and muscles of the foot and ankle, which occurs rapidly in the first year of life.
The actual operation that is performed involves performing soft tissue release in multiple regions, which means loosening several of the abnormally tightened ligaments or tendons, such as the Achilles tendon, in order to realign the foot properly. Placement of a cast on the lower leg and foot is also a basic part of treatment, and this may occur either in the operating room immediately following the surgery or 1 week following the surgery. To maximize the healing of the foot and ankle following the operation, this cast must be worn for a period of 4-6 weeks. Many orthopaedic surgeons also prescribe the use of a splint after the cast is taken off, which children may be asked to wear for up to 2 years.
