Care and treatment of Clubfoot
Podopaediatrics (the branch of foot care that specifically deals with children) can help to treat a number of different childhood abnormalities of the foot that can affect a young person’s movement for life. One of the conditions that can benefit substantially from podiatric care is clubfoot, a condition described as a congenital abnormality because it affects a child from birth.
What is clubfoot?
Clubfoot is the colloquial term for a condition also known as talipes or congenital talipes equinovarus, usually and conveniently abbreviated to CTEV. This is, as mentioned above, a congenital deformity that can affect either one or both of a child’s feet. About half of the cases of clubfoot reported each year affect both feet (are bilateral), and the condition affects more male children at a ratio of 2:1 (male: female).
There are two distinct types of clubfoot, postural and structural TEV, both of which present with roughly the same deformity but differ in terms of how clubfoot is caused. It has been traditionally assumed that structural clubfoot occurs because of genetic factors that affect the development of the foetus, whereas postural clubfoot is a consequence of other factors like a breech birth (when a child is born in an abnormal position which can stress joints and limbs).
Clubfoot distinctly affects three joints of the foot, the ankle joint, subtalar joint, and talonavicular joint, all of which link to a large bone in the ankle called the ‘talus’, from which clubfoot conditions have earned the name ‘talipes’.
The condition can make it extremely difficult to walk because the foot is deformed in such a way that it skews sharply inwards. The ankle joint doesn’t have its normal range of movement, and ultimately gait becomes severely impaired. Without treatment, clubfoot can affect a child’s mobility for the rest of their life.
There are a number of approaches to treating clubfoot, some surgical, and some non-surgical. Podiatry is closely involved in both the treatment and recovery aspect of clubfoot, as even after the deformity has been treated particular needs to be taken to preserve the foot and ensure its recovery. Treatment is absolutely essential from birth to prevent clubfoot from developing into a serious disability.
Physiotherapists and podiatrists will usually work together to address clubfoot, the former being responsible for manipulations and exercises that strengthen support muscles and stretch the various tendons and ligaments involved in the joint. Some podiatrists with appropriate training can help in this regard.
On top of manipulations orthotics and braces are needed to realign the foot and deformed ankle joint. Orthoses are supporting footwear that correct deformities of the foot and allow for a normal, healthy walk. Where clubfoot is concerned, orthotics can include casts, custom foot orthoses, or knee ankle foot orthoses. Which orthotic method is best suited for a child will depend on their foot, and each child with clubfoot will need to be carefully assessed to determine which method of realignment would work best.
To complement these methods two minor procedures can sometimes be performed, these include a tenotomy and anterior tibial tendon transfer. Both methods aim to relieve the pressure that clubfoot can exert on important structures in the ankle. A tenotomy is used in about 8 out of 10 cases and releases tension from the large tendon running down the back of the foot (Achilles tendon). An anterior tibial tendon transfer effectively moves a long tendon from the first to the third toe, relieving tension which forces the foot inwards. Podiatrists with the appropriate post-graduate qualifications in foot surgery can perform these surgeries, or alternatively a medical surgeon can be arranged to perform them.
Major surgical treatment is only occasionally used where other methods have failed to correct clubfoot. If surgery is necessary, then it is arranged between 9-12 months after birth, but even after surgery physiotherapy and podiatry are still needed to aid in recovery. Where possible surgery is avoided because of the risk of scarring within the foot, this can cause a number of problems as a child grows older which can affect growth and function.
The modern management of clubfeet is extremely effective, and a number of famous people, including famous athletes, have suffered from the condition, including England footballer Steven Gerard.
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