Club Foot

Clubfoot is defined as a congenital foot deformity characterized by a kidney shaped foot that turns inward and points down. The forefoot is curved inward, the heel is bent inward, and the ankle is fixed in planter flexion with the toes pointing down. Shortened tendons on the inside of the lower leg, together with abnormally shaped bones that restrict movement outwards cause the foot to turn inwards. A tightened Achilles tendon causes the foot to point downwards. The medical term for clubfoot is talipes equinovarus. It is the most common congenital disorder of the lower extremity. There are several variations, but talipes equinovarus being the most common. Clubfeet occurs in approximately 1 in every 800-1000 babies, being twice as common in boys as girls. One or both feet may be affected. Clubfoot is most common in children who suffer from spina bifida who have an L4 or L5 motor level. Many orthopedic surgeons instead of serial casting suggest early taping and gentle manipulation followed by an application of a well-padded splint. The reason for this is because serial casting can cause skin irritations and breakdown. Another technique manipulation and casting is a treatment that begins shortly after birth. It involves slowly stretching out the tightened muscles and holding the foot in an improved position with a cast. The casts are made of plaster and extend from the toes to either just above the knee, or just below it. Adduction of the foot is usually corrected first, followed by inversion of the hindfoot, and lastly the plantar flexion. The casts are changed frequently, each time repositioning the foot a little closer to normal. For the first two-three weeks, the casts are changed every second to fourth day. Cast changes are then decreased to once every one-two weeks. This treatment continues until the child is three to six months old. This method of treatment is distressing to the infant for only a short period of time. For this reason