Clubfoot Facts

• Clubfoot is one of the most common birth defects.  The heel and toes turn inward to the extent that it looks like the feet are upside down, with the soles pointed upward.  Frequently, the blood supply to this area is abnormal.
  
• During infancy clubfoot does not cause pain. In fact, untreated children will begin to stand and even walk at normal developmental stages.  However, the child will walk on the outside border of the foot.
  
• A child who is not treated will grow up to have a severe functional disability.  They will not be able to wear shoes and the foot will eventually become painful, prohibiting participation in most sports and even certain forms of employment.
  
• Clubfoot effects approximately one in every 500 to 1,000 newborns, making it one of the most common, non-major birth defects.  Half of these children will have both feet effected.  Boys are more frequently effected than girls.
  
• There is no known cause of idiopathic clubfoot deformity.  However, possible contributors include genetic predisposition, viral infection, lack of sufficient amniotic fluid and maternal smoking.
  
• Clubfoot has a greater chance of being fully corrected if treatment is initiated in the first weeks after birth given the favorable fibroelastic properties of the ligaments, capsules, and tendons.  Extensive surgery induces fibrosis and stiffness.
  
• Traditional surgery for clubfoot costs about four times more that the Ponseti Treatment.

Frequently Asked Questions

• If my child has clubfoot, how soon after birth should I bring my child in for an appointment? 
  It is not necessary to come to Clubfoot Clinic immediately after being discharged from the hospital.  It is recommended that parents bring their newborn in one to two weeks after birth.  This will give parents time to bond with their child before casting begins and this period of time with not negatively effect the treatment outcome.
  
• What is the Ponseti Method and what does it involve?
  The Ponseti Method is a non-surgical treatment for correcting clubfoot.  It involves three phases: four to eight weeks of weekly casting, a tenotomy or cutting of the achilles tendon which is performed in the clinic and special shoes connected by a bar.
  
• How many weeks does the casting procedure generally last?
  Initially 4-8 weeks of weekly casting, followed by a tenotomy (cut the achilles tendon) which is a minor office procedure, then 3 weeks in a final cast. Thus, a baby who is treated from birth will have completed all casting by age 3 months.
  
• How long, then, does the child need to wear the Denis Brown bar and shoes?
  When the last cast is removed at three months, the shoes and bar are applied. The child wears them day and night for three months (from age 3 till 6 months). At age 6 months, they switch to a nighttime only protocol, and wear the shoes and bar only at night, for about 3 years.
  
• What if my child kicks off his shoes?
  Parents have a very important role once the child is put in shoes with the bar.  After the first day or two, infants become accustomed to the shoes and play as normal.  Parents may also teach the child to move their legs at the same time, making it easier for the child to learn to move about.  If parents are not vigilant and strict about keeping the shoes on, this can cause the feet to relapse.
  
• At what point is no more treatment necessary?
  At age 2-4 years, it is usually possible to stop using the shoes with a bar. About 15% of babies require an additional surgical procedure when they are about 2-1/2 years old to help balance the strength of the muscles about the foot. This procedure is called a tendon transfer.
  
• Is the Ponseti Method an exact science?
  It is a hands-on technique. It is best done by a qualified and motivated physician, rather than delegated to junior doctors or orthopedic technicians. Nonetheless, it is not difficult to learn or teach, and any orthopaedic surgeon or orthopaedic technologist can be taught to do the manipulations and casting correctly.
  
• Can any doctor claim to use Ponseti's method and how is a parent to know who is legitimate?
  There is no official certification. Anyone can theoretically make the claim that he or she is doing the Ponseti Method.  Dr. Herzenberg has encountered many cases in which parents were told they were receiving the Ponseti Method, but infact, the treating physician was making significant deviations from the orthodox Ponseti Method. These deviations usually result in less than satisfactory results. The Ponseti technique is characterized by long leg casts, reapplied weekly and parents should see positive change in the foot after just three to four castings.
  
• What long-term research has been done on this technique and what do the results indicate?
  Dr. Ponseti published his results many times, and his partner, Dr. Dietz has published Ponseti's results with 30 years follow up. This is one of the best long-term outcome studies in the entire orthopedic literature. They found that Ponseti’s 30 year follow-ups were functioning as well as patients who did not have clubfeet.
  
• How many infants has Dr. Herzenberg treated with the Ponseti technique?
  Dr. Herzenberg has treated 87 babies with the Ponseti Method.