By Kathy Hubbard
In W. Somerset Maugham’s “Of Human Bondage” the protagonist has a clubfoot. I just started to read this novel and it occurred to me that I know very little about clubfoot. I, like many of you, have never met someone with this common defect.
The fact is that one infant out of a thousand live births will have clubfoot. It is the most common congenital (there at birth) disorder of the legs. It can range from mild and flexible to severe and rigid.
The Academy of Orthopaedic Surgeons explains, “Clubfoot is a deformity in which an infant’s foot is turned inward, often so severely that the bottom of the foot faces sideways or even upward. In clubfoot, the tendons that connect the leg muscles to the foot bones are short and tight, causing the foot to twist inward.
Although clubfoot is diagnosed at birth, many cases are first detected during a prenatal ultrasound. In about half of the children with clubfoot, both feet are affected. Boys are twice more likely than girls to have the deformity.”
There is no known cause of clubfoot. Rubin Institute for Advanced Orthopedics website says that contributors may include a genetic predisposition, viral infection, lack of sufficient amniotic fluid and maternal smoking. St. Louis Children’s Hospital Center for Foot Disorders says that theories include that a baby’s foot stops growing at a certain point; there is pressure on the baby’s foot in the mother’s womb; one of the bones or some of the muscles in the foot don’t form properly; or heredity.
The condition is painless, and a child develops normally and is able to stand and walk albeit on the outside border of the foot. However, without treatment the child eventually will have severe functional disability.
“They will not be able to wear shoes, and the foot will eventually become painful, prohibiting participation in most sports and even certain forms of employment,” Rubin says.
There are two basic classifications of clubfoot. Isolated (idiopathic) clubfoot is the most common, which means that the child has no other medical problems. These children can often be treated without surgery. Nonisolated clubfoot may occur in combination with various neuromuscular disorders. These children may be more resistant to treatment and may require one or more surgeries.
The gold standard for treatment today is called the Ponseti method and it ideally begins shortly after birth although older babies have successfully been treated using this method.
“The baby’s foot is gently stretched and manipulated into a corrected position and held in place with a long-leg cast (toes to thigh). Each week this process of stretching, re-positioning, and casting is repeated until the foot is largely improved. For most infants, this improvement takes about six to eight weeks,” the AAOS says.
“After the manipulation and casting period, most babies will require a minor procedure to release continued tightness in the Achilles tendon. During this quick procedure (called a tenotomy), the doctor will use a very thin instrument to cut the tendon …A new cast will be applied to the leg to protect the tendon as it heals…. By the time the cast is removed, the Achilles tendon has regrown to a proper, longer length, and the clubfoot has been fully corrected.”
But that’s not the end of the treatment. It continues with bracing to make sure the clubfoot doesn’t recur. This is an important step, although it can be demanding on parents and care-givers it’s essential to prevent relapse. Full time at first, the bracing is eventually reduced to sleep time until the child is around three or four years old.
There are other methods of treatment, and as stated already, some children will require surgery. Your pediatrician and orthopedic surgeon will map out the best plan for your child.
The good news is that although the treated clubfoot may be slightly smaller than the normal one; and that there may be a slight reduction in the size of the lower leg muscles these differences don’t cause long-term problems.
Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at 264-4029 or kathyleehubbard@yahoo.com.
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