Resources for children coming to the orthopaedic clinic (for Clubfoot)

Introduction

Clubfoot is a complex deformity. The cause of clubfoot is still unknown (idiopathic). It is a deformity that affects the foot, the calf muscle, tendons and bones of the foot.

It tends to affect boys more than girls and it can vary from mild to severe. One (unilateral) or both (bilateral) feet can be affected. Clubfoot is more common in Māori and Pacific Island families and there is often a tendency for clubfoot to affect more than one family member (familial).

Treatment

Starship Child Health has a dedicated weekly Ponseti clubfoot clinic. At the initial appointment you will receive a full orthopaedic assessment and the recommended treatment is discussed with you. Treatment can usually start the same day. Occasionally babies have additional problems, along with clubfoot, which might mean treatment varies.

The Ponseti method is widely considered the best treatment currently available for managing clubfoot. This treatment is provided by an experienced team trained in the Ponseti management of clubfoot. The aim of the treatment is to correct the club foot early using minimal surgery and then hold the corrected club foot whilst the children grow, so that the child can participate in all normal activities, with pain-free, flexible feet, and wear normal footwear.

Plaster Casts

After gentle stretches full length, above knee plaster casts are applied, gradually realigning the foot. Weekly cast changes are required until the foot is ready for the next stage of correction (usually 4-6 casts).
Your team will let you know when your baby is likely to need the tenotomy procedure.

Tenotomy

Is a small procedure where the achillies tendon (heel cord) is surgically cut. Typically this is done under a local anaethesia in the clinic. A plaster cast is applied after the procedure. This cast stays on for 3 weeks whilst the tendon heals in the new lengthened position.

Boots and Bar

The boots and bar brace (B&B) is a special brace fitted after the post tenotomy cast(s) are removed.
The brace allows the corrected club foot to stay in a good position whilst the children continue to grow. It is essential that the brace is worn as recommended to maintain a well corrected club foot.

For the first 3 months the brace is worn for 23 out of 24 hours, with 1 hour a day out of the brace for bathing etc.

After the first 3 months the brace is worn for 12 hours in a row overnight (eg, 6pm to 6am), every night and at nap times until the age of 4 years old.

Monitoring and Maintenance

Wearing the boots and bar brace is a critical part of the successful treatment of your child’s feet. During the first four years you will have regular appointments to monitor your child's feet and check the brace.

Once your child has completed their boots and bar treatment (age 4 years) they will continue to need regular follow up appointments. Children are still growing and so a relapse of the clubfoot deformity is still possible. Some club feet will require further treatment such as more plaster casts and sometimes further surgery may be recommended. The type of surgery required would depend on the individual child’s foot/ feet. By attending all your follow up appointments, early detection of a relapse and the need for any potential further treatment can be managed early.

See the video below for visual instructions on fitting the boots and bar.