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Approximately one in 1,000 newborns has a clubfoot. In most cases, the deformation of the baby’s feet is congenital. However, acquired clubfeet are also possible.
The clubfoot usually describes several deformities. For example, the sickle foot, the pointed foot or also the spreading foot and others. In the course of clubfoot, there is also a shortening of the Achilles tendon. If it is a clubfoot in the baby, the therapy is carried out as soon as possible after birth, so that a promising success can be assumed. Nevertheless, the treatment is usually difficult and lengthy.
Clubfoot As A Deformity Of The Feet
In most cases clubfeet are congenital, whereby one or both feet can be affected. This is a deformity of the extremities, with a combination of different foot deformities. Often it is an inward rotation of the feet, in which the sole of the foot points inward. The lower leg muscles of the affected children also show various anomalies. Furthermore, the Achilles tendon is shortened. Also conspicuous are a disturbance in the development of the lower spinal cord and a marked weakness within the calf muscles. In contrast, the posterior tibial muscle is overweight. The lateral ligaments are shortened between the fibula and the talus. The shortened ligaments cause an increasing pointed foot position. In addition, there are acquired forms, also known as neurogenic clubfoot. Acquired clubfoot is in many cases the result of nerve undersupply or injury.
Causes Of Clubfoot In Babies
Approximately one in 1000 children are born with club feet. Interestingly, boys are affected twice as often as girls. So far, there is no clear explanation for this peculiarity. Various causes are under discussion: an unfavorable position of the unborn child within the uterus
- Congenital birth defects that occur mechanically.
- A clear and long-lasting reduction of the amniotic fluid.
- Neural ear malformations, whereby clubfoot may be a concomitant symptom.
- Folic acid inhibitors during pregnancy.
- In the course of various syndromes, which can often be detected during prenatal diagnostics (for example trisomy 21), clubfoot often occurs.
Acquired clubfoot can be caused by muscle and nerve weakness. Injuries and infections can also lead to clubfoot or sickle foot.
Effective Treatment Of Baby Feet – Clubfoot And Sickle Foot Therapy
Different methods are given for the therapy and correction of baby feet. In principle, the degree of severity determines the chosen therapy measure. An early start of the therapy is crucial for success.
Conservative Treatment Of Baby Feet With A Present Clubfoot
The clubfoot cast is often used. Basically, this cast is applied as a thigh cast. This allows a much better redression of the foot to the outside. Furthermore, lower leg casts tend to slide down and thus cause pressure points. To achieve an outward redression, it is important to bend the knee joint by at least 60 degrees. Appropriate fixation of the joint is provided by the cast. The pointed foot position is maintained for the time being in this step. A final correction of the pointed foot is usually done by tendon lengthening.
Treating Clubfoot In A Baby After Ponseti
Ponseti treatment focuses on manual redression. There is a gradual correction based on anatomical considerations. Often, after three to eight clubfoot casts, surgery is not required, so correction is complete over the cast. Once the plaster re-dressing is complete, children are fitted for a special splint. Initially, it is necessary to wear the splint all day. Over time, the daytime wearing time is shortened. After another three months, the splint only needs to be worn during the night and during naps. Overall, the wearing period extends over the first four years of life.
French Method Of Clubfoot Treatment
The French method focuses on dynamic movement therapy. Within the first days of life, the affected child is entrusted to an orthopedist or a specialized physiotherapist, who initially corrects the clubfoot four to five times a week. Later, careful treatment is given three to four times a week. The position of the foot is changed in small steps within the first months of life. Adhesive tissue is loosened and the affected muscles are stimulated by movement. After the manual therapy is completed, fixation is done with taping and sub-gypsum shells. If the results are successful, the number of weekly treatments and therapies is reduced to twice. It is important to note that the knee and hip are not restricted in movement during this treatment. However, if no heel correction can be achieved during this treatment, an Achilles tendon transection is necessary at the age of three to four months. It should be mentioned at this point that the French method is a very demanding therapy. Only a few practitioners are trained accordingly.
Sicklefoot And Clubfoot Treatment In Babies According To Zukunft-Huber
The treatment according to Zukunft-Huber describes a manual therapeutic treatment that takes into account the normal development of the baby’s feet within the first year of life. Alternatively, there are various starting points for the treatment of a sickle foot, a bent foot and a flat foot as well as other malpositions. The affected child receives bandages during this therapy. The respective parents are instructed in detail about the treatment. The advantage of this method is that neither splints nor casts nor operations are necessary. The child’s ability to move is not restricted in any way. However, three 30-minute therapies must be carried out daily by the parents themselves. This requires a considerable amount of time.
Surgical Treatment Of Clubfoot
If structures are present that cannot be treated conservatively, additional surgical treatment of baby feet should be performed at the age of three months. During this surgery, the child’s Achilles tendon is lengthened. The alignment between the talus and the calcaneus is also corrected. In some cases, it is further necessary to cut different ligaments. Lengthening or reduction of the ligaments may also be performed in this context. The goal of surgical treatment is always the complete correction of the foot.
Further Treatment Options In The Presence Of Clubfoot
In addition to the above-mentioned methods, it is also possible to treat clubfoot by means of insoles, in which case a three-point correction system is considered. Furthermore, there is the so-called anti-varus shoe. This is significantly narrower medially than a normal shoe and corrects the malposition of the foot. The Anti-Varus shoe is mainly used to treat the sickle foot.
Orthoses For The Treatment Of Clubfoot In Babies
If, in addition to the clubfoot, the lower leg is also turned inward, the upper leg must also be included in the treatment. For this purpose, it is necessary to take a model cast with the best possible corrective position of the foot. The orthoses used should be made of a light and flexible material. In this context, polyethylene is often used. This allows for micro-movements of the foot. In addition, these lightweight orthoses create improved corrective tolerance. Inside, the orthoses should be equipped with a closed-cell foam made of polyethylene. However, in children under six months of age, the material can cause massive irritation to the skin. In this regard, terry cloth or deerskin is often used. Constructively, different orthoses are available, such as:
- Orthoses with corrective traction.
- Upper leg shells.
- Lower leg shells.
- Orthoses with plantar joint.
In most cases, however, an upper-lower leg splint is prescribed. This is particularly suitable for smaller children. Within the splint, the knee joint must always be fixed. This is the only way to keep the foot in the right direction. Since children grow the most at night, the splint is often worn only at night.
FAQs On The Subject Of Clubfoot In Babies
1. What Causes Clubfoot?
The causes of clubfoot are not yet fully understood. On the one hand, there is the more common congenital clubfoot. On the other hand, the deformity can be acquired.
2. Is Clubfoot Hereditary?
Altered genes can contribute to the development of clubfoot. Thus, there is a possibility of hereditary condition. Various factors can contribute to the development of deformities of baby feet in case of predisposition.
3. Is Clubfoot A Disability?
If clubfoot or sickle foot is not treated, it is a significant disability that significantly limits movement.
4. Is It Worth Applying For A Severe Disability?
If clubfoot is present, it is a significant disability that primarily affects movement. An application for a severe disability is therefore advisable.
5. Is The Child Entitled To A Degree Of Care In The Case Of Clubfoot?
Under certain circumstances, it may be possible for the affected child to receive a degree of care. The decisive factor for the application is the degree of care required. This must be increased in comparison to children of the same age. It is increased, for example, by the application of splints, by various, time-intensive therapy measures. A nursing consultation can be helpful in this context.
6. Are There Any Late Effects In Connection With Clubfoot?
If there is no adequate treatment of clubfoot, the deformities intensify over time. Stiffening of the baby feet occurs, which makes conservative treatment impossible. Furthermore, a pronounced club foot or sickle foot causes pain during weight bearing. If, on the other hand, immediate and consistent treatment is given, the chances of success are very good.