Clubfoot is one of the most common pediatric orthopaedic conditions. It affects 1.2 of every 1,000 live births and is bilateral in 50 percent of patients. It affects males slightly more than females.
Ponsetti Clubfoot Method
The goal of treatment is to reduce or eliminate all of the components of the deformity so the child will have a functional, mobile, and painless foot in normal position. To achieve that goal, treatment consists of serial casting on a weekly basis, surgery, and splinting. The casting is done for approximately six weeks. Immediately before casting, the foot is massaged and manipulated to stretch the contractures.
In about 90 percent of babies with clubfoot, the Achilles tendon needs to be cut. This procedure is done before the last casting. It is called a tenotomy and is done in the clinic, under a local anesthetic with a thin scalpel. Consequently, you may see a few drops of blood on the plaster. The tendon reattaches in two to three weeks as it heals.
Following surgery please notify your doctor of any of the following:
- Any increased drainage on the cast
- Foul smelling odors coming from inside the cast
- If the skin at the very edge of the cast becomes very red, sore, or irritated
- If your baby runs a fever of 38.5 C/101.3F or higher, without any explainable reason, such as cold or a virus
After hours or on the weekends please call (573) 882-4141 and ask for the orthopaedic resident on call.
Your baby may be a little fussy or restless for 24 hours after the cast application. Please make sure you check your baby by doing the following:
- Check the foot every hour for the first 12 hours after application, then four times a day. To do this, simply pinch the baby's toes, watching for the return flow of blood. The toes will turn white and then quickly returns to pink if the blood flow is good. This is known as "blanching." If the toes are dark and cold to touch and do not blanch, the cast may be too tight. If this occurs, the casts should be checked.
- The baby's toes should be exposed at all times. If you cannot see the toes, it may be that the cast has slipped; therefore, proper stretching is not being maintained. Please notify the office for further instructions. The phone number is (573) 884-2522.
- Keep the cast clean and dry. Change your baby frequently to keep the cast from getting soiled.
- Immediately post casting, the cast should be placed on a soft pad or pillow to prevent denting. When your baby is lying on his/her back, place a pillow or soft padding under the cast to elevate the leg. So that the heel extends just beyond the pillow/padding. This helps prevent the cast from breaking apart and more importantly, prevents pressure on the heel, which could cause a sore.
On the day of your appointment for cast change, put your baby in a basin of warm water with a teaspoon of vinegar or dishwashing soap. Make sure the water is getting inside the cast. It usually takes 20 to 25 minutes. After soaking, wrap the cast in Saran wrap, a plastic bag and a towel. The cast will be removed when you come into clinic.
After removal of the last cast, and in order to maintain the correction, your baby will be fitted with a Dennis-Brown splint (shoes attached to a metal bar). Your baby will wear this splint 23 hours a day for the next two to three months, then at night and during naps for an additional two to four years.
Your baby may have some discomfort in wearing the splint the first and second night; however, it is imperative that the splints NOT be removed. Correction cannot be maintained if splints are not worn as prescribed. When splints are removed, ordinary shoes may be worn. Yearly clinic visits are scheduled to check for maintenance.
If baby has trouble with slipping of the shoes:
- Tighten laces or strap
- Use snug socks with non-slip soles
- Try round 40-inch shoelaces
If baby develops blisters:
- Call the Orthotic Shop at (573) 882-6191 to get splint checked
- For redness, use a Band-Aid
- For an ulcer type blister, discontinue splint to allow blister to heal; just increase the stretching exercises
- Try blister block, an over the counter medication
Stretching your baby's foot when out of the cast or splint is very important and needs to be done with consistency. You will be shown how to stretch. Stretching should be done four times a day or more if able, doing 20 to 30 repetitions at a time. It is not painful; however, it may be a little uncomfortable. It is important to maintain flexion. Sometimes a slight popping might be felt as you stretch, usually this is scar tissue that has formed after the tenotomy.
Reference: Faulks, Shawne and Luther, Brenda: Changing Paradigm for the Treatment of Clubfeet. Orthopaedic Nursing;2005, 25-32.
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