CLUB FOOT

• It is a developmental deformity of the foot of unclear etiology.
• 1 : 1000 labours depending on population.
• More common in males.
• 50% of cases are bilateral.
  

  A baby with bilateral clubfoot deformity

PONSETI technique is the most applicable method all over the world.

This conservative method of treatment depends on the bone and joint remodeling with every manipulation and casting. The usual number of casts varies from 4 to 6 according to severity of the deformity.

Series of casts.

By the end of casting 90% of cases require a minor surgery for lengthening of the Tendo-Achillis followed by a cast for another 4 weeks. After removal the last cast; bracing should  start  for  23 hours daily for 5 to 6 months, then we start to decrease splinting time gradually until it is confined to night  and nape time. Bracing should continue until the age of  3 to 4 years.

Denis Brown splint

Residual foot deformity occurs in 20% of cases around the age of 3 years and is treated with tibialis anterior tendon transfer to medial cuneiform bone of the foot to pull the latter outwards.

Since 2000 we have treated hundreds of cases by the PONSETI method and follow up of these cases shows the effectiveness of this conservative method.

Finally, the complete surgical method that was used in the past is not advocated nowadays due to its functional complications, cosmetic problems and affection of the normal growth of the foot.

A baby with bilateral clubfoot deformity treated by Ponseti technique:

Before treatment

3 years follow up

9 years follow up

Another case treated with Ponseti technique:

Before treatment

5 years follow up with residual adducted forefoot deformity

6 years follow up and after tibialis anterior tendon transfer