Clubfoot Casting Care
Every three minutes, a child is born with clubfoot. Clubfoot Casting care at An Orphan's Wish was created to treat orphans born with clubfoot, who otherwise would not have an opportunity to have their feet corrected. The Ponseti Method of serial casting is used to gently manipulate the affected foot with a series of casts, changed weekly. Once the desired position is achieved, braces are worn to keep the correction, on a gradually reduced schedule, until the child is 4-5 years old. The children treated at An Orphan's Wish live in our residential facility until correction is achieved. Once the bracing protocol is well underway, the children are placed with a foster family. Most clubfoot patients stay in our facility between 6 and 9 months before moving to foster care.
WHAT IS CLUBFOOT?
Clubfoot, also known as talipes equinovarus, is a common congenital birth defect present in approximately 150,000 newborns worldwide every year. It affects boys slightly more frequently than girls and bilateral clubfoot (when both feet are affected) occurs in 30-50% of cases. The cause of clubfoot is largely unknown, but environmental factors and genetics are believed to play a part. When a child is born with the condition, the affected foot is turned upward and inward. If left uncorrected, the child would walk on the side or top of the foot. The goal of treating the clubfoot is to achieve a foot that looks and functions as much like a normal foot as possible. Most doctors agree that the initial treatment should be non-operative. Unfortunately, many doctors are not correctly trained in the Ponseti Method of serial casting, and surgery becomes too often the rule, instead of the exception.
ABOUT THE PONSETI METHOD OF TREATMENT
Dr. Ponseti began developing a method to correct clubfoot without surgery in 1948. Dr. Ponseti passed away in October of 2009, at the age of 95. He continued to treat children with clubfoot at the University of Iowa Children's Hospital, until just months before he passed away.
Ponseti's method involves a series of plaster casts, applied from toe to groin, changed every 5 to 7 days. The doctor gently manipulates the bones of the foot in a specific order. The cast holds the foot in the new position, gently stretching the tendons and ligaments. With each cast change, the foot is manipulated in small increments, until the last cast achieves full correction. Most children with clubfoot require 5 - 7 casts and only in atypical cases are more casts necessary. For a child treated from birth, no more than 9 casts are required to achieve full correction.
A percutaneous tenotomy is required in approximately 80% of patients to lengthen the Achilles' tendon to complete the correction. This procedure can be done in an office setting with local anesthesia. It involves a small poke with a tiny scalpel in the child's heel and requires no stitches to close the wound. After the tenotomy, the final cast is applied, which stays on for 3 weeks in order for the tendon to regenerate to the proper length. When the last cast is removed, the child begins wearing a brace that holds the corrected foot in a stretched position, essentially 'retraining' the body to recognize the new, corrected, foot alignment; similar to the use of a retainer after orthodontic braces are removed.
The brace consists of two shoes, connected by a bar. The brace is worn for 23 hours a day for the first 3 months. Over time, the daily bracing hours are gradually reduced. By the time the child is walking, the bracing hours are reduced to bed time only. The brace is worn at night until approximately 5 years of age. The tendency for the foot to relapse remains active for years, but diminishes over time as the child grows. The exact causes of relapse are still being studied. At this time there are no criteria to determine whether or not a child's foot is prone to relapse. Wearing the brace to keep the foot stretched gives the child the best chance to avoid relapse. After they are released from the brace wear, there are no special requirements and, assuming the child has no additional health issues, they may pursue an active lifestyle with no restrictions. When applied by a skilled physician, Ponseti's method is successful in achieving complete correction in nearly 100% of patients with congenital clubfoot.
WHY IS PONSETI'S METHOD BETTER THAN SURGERY?
The Ponseti method has many advantages over surgical reconstruction. The first consideration is how much easier gentle manipulations and serial castings are for the patient to endure. Casting is not painful and often the child watches curiously as the foot is gently manipulated and as the plaster casts are applied. Secondly, surgery often makes the clubfoot 'look' correct, but internally the components of the foot and leg have been weakened. Excessive scar tissue, stiffness and limited motion can be effects of surgery, occurring early in the patient's life and lasting a lifetime. This leaves the patient with a somewhat normal looking foot, but with potentially debilitating foot pain. Patients who have had their clubfoot reconstructed surgically often require additional surgeries over time; which can lead to more scar tissue and complications.
The Ponseti casting technique actually puts the bones of the foot back into the proper alignment by using manipulation and tenotomy, resulting in a corrected foot, without the stiffness and pain. Another advantage to Ponseti's casting technique is that it can be provided by any medical professional (physical therapist, cast technician, midwife etc.) properly trained in the method, a surgical specialist is not needed. It is also much less costly and all treatment is typically done on an outpatient basis. The Ponseti method has been demonstrated as a viable method of clubfoot treatment in areas of the world where treatment for children is not typically available due to expense and/or limited medical staff.
WHAT A PRECIOUS GIFT!
Children with untreated clubfoot, especially those born in countries where treatment is not readily available, aren't able to walk correctly and eventually, the uncorrected foot becomes so painful that walking becomes extremely difficult if not impossible. Dr. Ponseti's method is slowly reaching these children in every remote corner of the world. When you give a donation or sponsor a child with club foot, you give a most precious gift to children who would otherwise have a bleak future. It is a gift of walking, running, and dancing, with beautiful pain-free feet and enjoying life to the fullest... that's a gift that lasts a lifetime!Sponsor a child with clubfoot
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