Clubfoot (Positional Talipes)

Idiopathic (unknown causes) clubfoot is an isolated deformity of the foot and leg that is identifiable in utero and consists of four components:

  • Equinus - where upward bending motion of the ankle joint is limited
  • Hindfoot varus - a varus (moving out from the midline of the body) position of the calcaneus (the heel) which is adducted (moving towards the midline of the body) and rotated inwards.
  • Forefoot adductus - causes the front half of the child’s foot to turn inwards
  • Cavus - a condition in which the foot has a very high arch

When untreated, children with clubfoot walk on the sides and /or tops of their feet, resulting in callus formation, potentially skin and bone infections, inability to wear standard shoes and substantial limitations in mobility.

Clubfoot has a strong tendency to relapse until four years of age and this is attributed to the original pathology. Relapses decrease after age four because the pathology that causes clubfoot ceases to exist.

Clubfoot typically doesn’t cause any problems until your child begins walking and standing. If the clubfoot is treated, your child will most likely walk fairly normally. They may have some difficulty with:

  • Arthritis
  • Poor self-image
  • Inability to walk normally
  • Problems stemming from walking adjustments

What Causes Clubfoot

As clubfoot is considered idiopathic (unknown) in nature, it is hard to identify a specific cause, however, various studies conducted, have suggested that clubfoot may be caused by:

  • Anatomical abnormalities
  • Elevated uterus pressure during pregnancy (still disputed)
  • Neuromuscular conditions
  • Inherited multifactorial gene traits

How Can Children’s Orthotics Help?

At Children’s Orthotics, our skilled multidisciplinary team will work closely with you and your child to identify the best treatment options available to your child’s needs.

French Technique - French functional physical therapy method consists of daily manipulations of the newborn’s clubfoot by a specialised physical therapist, stimulation of the muscles around the foot and temporary immobilisation of the foot with elastic and nonelastic adhesive taping

Kite’s Technique - this is a method in which manipulation can be started soon after birth. This concept is derived from a three-point pressure system. This is a conservative treatment that is done by applying an intervention every seven to fourteen days. Each new cast applied offers gradual gentle manipulation to the foot and ankle. Treatment duration is approximately 6 months.

Ponseti Technique - a similar concept to the Kite’s technique, the Ponseti technique consists of a specific manipulation of the clubfoot deformity, followed by the application of a plaster cast with the foot in the corrected position. A minor surgery to the Achilles tendon is done prior to the final cast to gain complete correction in most children.

Following this treatment, your child will be placed in a Foot Abduction Orthosis (FAO). Compliance with the FAO after treatment is crucial to prevent any reoccurrence.

At Children’s Orthotics, we understand the importance of educating our patients and their family members. By empowering parents with the knowledge necessary, the chances of reoccurrence are reduced.

What Types of Orthotics Might Be Effective

The above technique can be achieved through specialised orthotic splints and braces, such as:

  1. Foot Abduction Orthosis (FAO) - an orthotic device that places the foot in a position of abduction (feet pointing out) and dorsiflexion (foot being pulled up at the ankle joint) following correction and is an integral part of the Ponseti treatment process, making up phase two of the treatment.
  2. Night Splint - a splint that holds the foot with the toes pointed up. This position applies a constant, gentle stretch to prevent contractures of the Achilles tendon and calf muscle.

What Might the Assessment Procedure Involve

Your orthotist will ask you questions about your child’s daily activities and medical history. The paediatric orthotist will undertake a gait examination and watch them walk, paying attention to movements at their affected joints and making observations of how their body moves. Following this, your child’s treatment options and goals will be discussed and a prescription made. Any devices that are required will be fabricated using materials chosen specifically to meet their requirements and then a fitting session arranged. All of our prescriptions and fittings are followed by a review to ensure that the treatment is effective and any adjustments can be made.

To get in touch or arrange an appointment, you can call us at 0330 088 3949 or email office@orthotics.co.uk.

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