Clubfoot - Talipes
Clubfoot - Talipes
Clubfoot - Talipes
Your Notes
Acknowledgements: steps wishes to thank Miss Naomi Davis, Consultant Paediatric Orthopaedic Surgeon, Booth Hall Children’s
Hospital, Manchester and Mr M K D Benson, Consultant Orthopaedic Surgeon, Nuffield Orthopaedic Centre NHS Trust, Oxford
for their help in the preparation of the Clubfoot Leaflets and all parents who provided feedback and photos especially Stella
Morris, Deborah Simpson, Debbie Goodwin and Lauretta Aydinder.
Clubfoot can be classified into the following groups: congenital, complex, • The chances of having a second child with clubfoot are approximately
1 in 305
atypical, positional, or syndromic.
• Research has suggested that smoking during the first three months
Congenital clubfoot is by far the most common and most affected of pregnancy is a risk factor and that there is an interaction between
children have no other major abnormalities. It is also sometimes referred smoking and family history which considerably increases the level of
to as isolated clubfoot or idiopathic (means cause unknown) clubfoot. risk when both factors are present2
Complex and atypical refers to feet which are resistant to treatment • It is also thought that clubfoot may be due to disruption in the
development of the foetus. In a normal foetus the feet are in this
Positional clubfoot occurs when an otherwise normal foot is held in position initially then turn as the pregnancy progresses. In a baby
a deformed position in the uterus (the womb), and thus is "moulded" with clubfoot this turning has not been completed. Research into
incorrectly, the foot is very mobile and may correct itself although this is currently being carried out at the University of Aberdeen3.
sometimes growth and development will be monitored.
When is Clubfoot diagnosed? Should I have the tests done?
Clubfoot is usually diagnosed either during pregnancy by an ultrasound
scan or at birth. ‘…each person should make an informed decision about
screening based upon appreciation of the risks and benefits,
’
Will there be anything else wrong with my baby? National Institute of Clinical Excellence.
In most cases clubfoot is an isolated problem but it is also an abnormality The Risks
which is present in other, more serious conditions so if your baby has There is a risk of about 1% of suffering a miscarriage when invasive
been diagnosed with clubfoot during a routine scan, more checks may testing is carried out.
be offered to find out whether she/he has other problems. The nature
of the tests depend on the policy of the individual healthcare provider Uncertainty can still remain after testing as false-positives and
but may include: false-negatives are possible.
Individual treatments are classified as either conservative or operative. The foot is then put into a final cast for 2 – 3
Your child is most likely to start with conservative treatment and may weeks and when this is removed the child
experience a range of treatments tailored to the position of the foot. has to wear boots attached to a bar. These
are worn 23 hours a day for about 3 months
Stretching (Conservative) treatments then at night and nap time until the child is
about 4 years old. At this stage the feet are
These aim to stretch the soft tissues of the foot and hold it in as normal already fully corrected. Wearing the boots
a position as possible using methods from the following list: physiotherapy, and bar is essential to prevent a relapse.
gentle manipulation, use of plaster casts, splints/strapping and
special boots. steps and Both Feet Forward have also produced a DVD and a separate
leaflet about the Ponseti Treatment.
Methods included in this category are:
Traditional methods – these are also based on manipulation, often
The Ponseti Method - an increasingly popular form of conservative by a physiotherapist. Between sessions the foot is held in place by
treatment which is becoming more widely practised in the UK now. It either strapping or a plaster of paris cast
was developed in the USA over 40 years ago and ‘long term follow-up
studies show that feet treated by Ponseti management are strong, flexible Operative treatments
and pain-free’ (Clubfoot: Ponseti Management. Global Help Publications).
During conservative treatment the foot will be monitored and it may
The method uses manipulation, gently become necessary to perform an operation to correct any remaining
rotating the bones and stretching the soft problems. Although the foot has proved too resistant for conservative
tissue, then the application of a plaster cast treatments alone the skin will have been well prepared for surgery as
from the toes to the groin to hold the foot it will have been made more supple by the stretching processes.
in position.
There are four main types of surgery.
This takes place every 5 – 7 days and most
children need 6 – 10 casts, correcting the The most common ones are as follows:
position of the foot a little more each time.
Operative treatments What is the long term outcome?
• Soft tissue release – lengthening or cutting the Achilles tendon and Most children do very well with treatment and will be able to go to school
releasing other ligaments and capsules at the back and inside border and take part in sporting activities. There has only been one long term
of the foot which are preventing the positioning required because study following children through to adulthood and this was specifically
they are too tight. to look at the results of the Ponseti Method. This study showed that the
• Tendon transfers – (e.g. the tibialis anterior transfer) to move use of this method resulted in similar levels of foot pain in mid life to
the tendons to a different position, so the function of the foot those experienced by people who were not born with clubfoot5.
can be improved.
Less frequently there may be: How do I decide what treatment to choose
for my child?
• Surgery on the bones of the foot – bony procedures such as
osteotomies that divide or remove bone to correct deformities, or, This is something you need to discuss with your child’s doctor and other
very occasionally, arthrodeses which surgically stabilize joints to enable health professionals but think about:
the bones to grow solidly together. This is usually carried out after the
child has stopped growing. • What type of treatments are offered at your centre? – remember
to ask them to describe them to you.
• Use of a circular frame such as the Ilizarov – a number of metal
rings held together with rods and fixed to the bone from several • What are the success rates for each type of treatment?
directions by thin wires under tension. By adjusting different • How is the severity of the condition measured and how does
components of the frame over a period of time bones can be this relate to the treatment offered?
lengthened, thickened or shortened and soft tissue can be stretched.
• What are the skills and experience of people at the centre?
Occasionally, a combination of these procedures may be necessary. • Are there any complications with the treatment?
• How does your centre measure the results of the treatment?
How long will my child need to see an • How much time will each form of treatment take?
orthopaedic surgeon? • How involved you will be in the treatment?
Most children need follow-up for a few years after treatment has finished, • If you choose a centre far from home are you able to travel regularly?
some surgeons may prefer to keep you child "on the books" until the feet • How will your family and friends respond to the treatment?
have stopped growing.
• Before you go, think about what you want to know. Jot down the
scan, even burst into tears in the room!
’
questions you want to ask.
• ‘ I was really very upset, and it spoiled my
Take your partner, friend or relative with you. If one concentrates
on asking the right questions, the other can take a few notes to
pregnancy, constantly worrying, and blaming myself.
’
help you remember what was said afterwards.
But it usually gets better…
• If you can’t have someone with you, think about taping the
conversation so you can play it back later
• If you don’t understand something, ask the doctor to explain further. ‘ He never stops running and jumping and
is full of energy, he has recently completed
Good ways to ask this include; "This is all very new to me, what do
you mean by……?"
the Ponseti Toddle, and is doing really well’
’
• The doctor may be very busy and if you don’t find out all you need
to know, ask if there is anyone else who can take you through the ‘ with a great doctor her foot
looks brilliant. Only last week
procedure. Often a doctor’s junior colleague will be able to explain
and may have fewer appointments to get through. The nurses at the
clinic or on the ward may be able to tell you more
they said how marvellous it looks.
’
‘ …. has now decided that
he wants to come to every
Is it normal to feel like this? class with me because he
People have all sorts of reactions – these are a few
wants to be a power ranger!!
’
‘ I was really upset on Tuesday afternoon ‘So much for talipes
and yesterday with worry, worrying if
stopping them doing things eh?
’
everything is going wrong?? Is it my fault??? etc!
’
‘ we found out he had clubfeet at our 20 week scan,
and then our minds were completely taken over
and we thought of nothing else until he was born!
’