New Hope for Children with Clubfoot
May 2002 — Finding out your newborn has a condition called "clubfoot" can be upsetting. Informing yourself about clubfoot and what treatments are available may help ease your worries.
When a baby is born with clubfoot, a condition that occurs in approximately one in every 1,000 births, the foot appears to point down and twist inward. It can occur in one or both feet and is not painful to the infant. If left untreated, however, it can cause serious problems as the child grows.
Treatment for clubfoot is started shortly after birth. In the past, the accepted method of treatment was a series of casts to try to "steer" the foot in the proper direction, followed by surgery to lengthen tendons and ligaments in the foot. This was followed by more time in a cast. Sometimes additional surgery was necessary the child grew older. However, in certain patients a fresh approach to treating clubfoot, utilized by pediatric orthopaedic surgeons Michael Jofe, MD, Randolph Cohen, MD, and Neal McNerney, MD, is providing new hope for kids affected by the condition.
"The traditional treatment has been to use a series of casts, which gave variable results but seldom completely corrected the problem," says Randolph Cohen, MD, pediatric orthopaedic surgeon on staff at Joe DiMaggio Children's Hospital, Memorial Hospital West and Memorial Hospital Pembroke. "When the child was about 6 months old, he or she would have to undergo an extensive surgery requiring a large incision. After that, the child would have to wear a cast for two months. In certain circumstances this technique is still the preferred method of clubfoot treatment."
The Ponseti Method
Several decades ago, Ignacio Ponseti, MD, head of the Pediatric Orthopaedics Department at the University of Iowa, pioneered a less-invasive procedure for treating clubfoot. Dr. Ponseti experienced very good results with this method, but his findings were not widely accepted by the orthopaedic community at the time. In recent years, however, the success of the "Ponseti casting" method of treatment has become more widely recognized.
"Dr. Ponseti developed a non-surgical treatment that met with some resistance in the orthopaedic community," says Dr. Cohen. "But Dr. Ponseti continued to exhibit great results with his method. He published his findings, and trained many others who in turn successfully 'exported' his technique around the United States and to other countries."
The Ponseti casting method begins as soon as the clubfoot is identified - ideally while the child is still in the hospital after birth. After gentle manipulation, a cast is placed on the affected leg from the toes to the thigh. The cast stays on for five to seven days, and is then removed. The leg is gently manipulated, and then a new cast is applied. This procedure continues for four to six weeks. The actual casting takes approximately five to 10 minutes each time.
Taking the Next Step
With the Ponseti method, the child must wear the Ponseti brace full time for about four months after the casting process is complete. Then, the child must wear a brace at night until he or she is about 2 years old. In about 20 percent of cases using the Ponseti method, a five-minute surgery is required to lengthen the heel cords through mini incisions when the child is around 6 weeks old. Some children require an additional surgery at age 2 to 3.
"The Ponseti method of treating clubfoot is gaining more acceptance in the medical community. So far, we have seen encouraging results. I think it's great that the Division of Pediatric Orthopaedics at Joe DiMaggio Children's Hospital is utilizing this procedure," says Dr. Cohen.
Treatment for clubfoot normally begins as soon as the deformity is identified, often in the newborn nursery. If you are interested in pursuing the Ponseti method for your child, check physicians' credentials carefully. Not everyone has been properly trained in this method. Ideally, a doctor should have actually studied with Dr. Ponseti or a physician who has trained with him.
For a referral to a physician, call the Memorial Healthcare System Physician Referral Service at (800) 944-DOCS.