http://www.mchlimo.com/baby-tights-with-shoes-attached/
Clubfoot Is Not A Life Sentence – Correcting Clubfoot With The Ponseti Method
“Parents of infants born with clubfeet may be reassured that their baby, if otherwise normal, when treated by expert hands will have normal looking feet with normal function for all practical purposes. The well-treated clubfoot is no handicap and is fully compatible with a normal, active life.” – Ignaçio Ponseti, M.D. (1914-2009)
Our son Alex was born with clubfoot in 2003. When I first read Dr Ponseti’s words above, I was inspired, encouraged and had hope for Alex’s future quality of life. If you are the parent or family of a child born with congenital clubfoot (talipes equinovarus), I hope it has reassured you a little too.
I’m not a doctor, or a physiotherapist or a nurse. I have no formal medical training at all. I’m the mother of a child born with clubfoot. I’ve lived through his treatment and I’ve researched his condition.
A description of clubfoot
Congenital Clubfoot is the most common lower leg deformity that occurs in otherwise healthy babies. The World Health Organisation estimates 100,000 children are born with congenital clubfoot every year, 80% in the developing world. Clubfoot can be either “unilateral” (one foot) or “bilateral” (both feet). In about 50% of clubfoot cases it is bilateral.
Clubfoot has been a recognized condition since ancient Egypt. Pharaohs Siptah and Tutankhamun had clubfoot, the condition was described by Hippocrates and the Aztecs.
Although clubfoot has been known about for centuries, it’s ‘idiopathic’, meaning that its cause is unknown. It’s generally agreed that Congenital Clubfoot develops after the first trimester of pregnancy. It is often picked up on ultrasound at around 16-20 weeks.
Clubfoot causes the foot to turn inward and point downward. The foot is usually short and broad, curved in a ‘kidney bean’ shape with a deep crease on the sole of the foot because of the curve. The heel feels ‘spongy’ because of the tight Achilles tendon which pulls the heelbone up. The calf muscles are usually smaller and less developed. Unless the clubfoot is corrected, normal walking is impossible, because the top of the foot is where the bottom should be.
Correcting clubfoot
Clubfoot surgery became more popular than serial casting during the 1950′s. In the 1990′s increased internet use by concerned parents of on-line support groups escalated the demand for non-surgical techniques, particularly the Ponseti Method. The method is now endorsed by professional surgical associations and the WHO.
The Ponseti method, devised over 60 years ago by Dr Ignacio Ponseti, avoids cutting the tight ligaments, tendons and joint capsules. It is a carefully constructed sequence of plaster casts and braces for children with clubfoot, based on his studies of the condition. Long term follow-up studies show superior results to operative techniques.
Typically the method takes about 4-6 weeks of plaster casts, changed every 5-7 days. For over 80% of cases, the tight Achilles tendon is cut in a minor procedure (tenotomy) and the corrected foot is put in a holding cast for 3 weeks to allow the tendon to regenerate longer.
When the final cast is removed, a ‘foot abduction brace’ is fitted – a pair of shoes attached to an adjustable bar at a specific width and angle.
This crucial part of the treatment helps prevent relapse of the clubfoot. It’s important that the feet are well corrected at this stage and the shoes well fitted so the baby is comfortable and can adjust to them. It’s a commitment for parents because the baby wears the brace for 23 hours a day at first, brace wear is gradually reduced until only worn at night until around age four. Most babies do adjust well to wearing the brace and it becomes part of their daily routine.
Treatment results
Dr Ponseti’s gentle, experienced hands corrected Alex’s clubfeet with three casts changed every five days and then Alex had the tenotomy. He had no pain, no invasive surgery, no anaesthesia and he adjusted well to wearing the brace.
Alex is now an active seven-year-old boy. He plays soccer, runs like the wind, and loves his judo classes. His feet are flexible and strong, a lifelong testimony along with thousands more children, to Dr Ignacio Ponseti’s vision and determination.
Tips for parents
* Join on-line support groups
* Find all the information you can on the condition
* Find a Ponseti doctor who treats a lot of clubfoot, travel far if you have to, it’s worth it
* Seek a second opinion if you are unhappy with the treatment or results
* Enjoy your baby’s milestones, don’t focus only on the clubfoot
* Share your experience with other parents, help spread the word on the Ponseti method
References
1. Congenital Clubfoot. Fundamentals of treatment (Ignacio V. Ponseti, Oxford University Press, 1996)
2. Ponseti International Association, Iowa
3. American College of Foot and Ankle Surgeons
About the Author
Karen Mara Moss lives in Johannesburg and has written columns for South African magazines since 2000.
Karen established STEPS South Africa in 2005. STEPS has enhanced the quality of life potential for hundreds of babies born with clubfoot. Karen has been nominated twice for Woman of the Year (Health category).
www.steps.org.za
Karen is author of a website with information for parents of babies with clubfoot – www.clubfoot.co.za