Clubfoot

Clubfoot treatment should ideally begin within the first weeks of life, when the child’s bones, joints, and tendons are most flexible. Most infants with clubfoot can be treated with a variety of nonsurgical methods. When those treatments are not effective, surgery may be considered.

Nonsurgical clubfoot treatments

The most common nonsurgical treatment for clubfoot is the Ponseti method, which consists of the following:

• Casting - Gentle stretching, repositioning, and casting of the affected leg(s) are done every week, typically for six to eight weeks. Each cast extends from the toes to the thigh.
• Achilles tenotomy - About 90% of babies need a minor procedure that uses a very thin instrument to cut the Achilles tendon and release it. It takes about three weeks to heal, during which time the tendon regrows to its proper length.
• Bracing - The child is placed in a boots-and-bar brace, which consists of shoes attached to an inflexible bar. The bar holds the feet up and out. While the child can come out of the brace for bathing, stretching, and physical therapy, it is typically worn full-time for three months. After the fourth month, most children start wearing the brace only when they sleep (naps and overnight) until they are four or five years old. Parents learn when and how to stretch the child’s foot during this phase of treatment—a vital component of their care. Compliance with this bracing regimen is the most important factor in avoiding the recurrence of the disease. 
• French method - Instead of casts, this method relies on taping, splinting, and regular sessions with a physical therapist. It is also known as the functional or physical therapy method.
• Taping and splinting - Each day, the baby’s foot is stretched, gently manipulated, taped, and splinted to maintain the range of motion. Visits to the physical therapist are typically three times a week, and parents learn how to perform the daily stretching and taping at home in between sessions. 
• Achilles tenotomy - Like the Ponseti method, the French method requires most infants to have a minor procedure after three months to release their tight Achilles tendon
• Maintenance treatment - To keep the clubfoot from coming back, the child’s caregiver must continue daily stretching, taping, and splinting until age two or three

Clubfoot surgery

Not all children with clubfoot respond well to nonsurgical therapies, and in some cases, the foot may return to a twisted position despite treatment. During clubfoot surgery, an orthopedic surgeon lengthens and repositions ligaments and tendons, such as the Achilles tendon, and adjusts the joints in the foot and ankle. The surgeon inserts pins to hold these structures in their proper positions and places the child’s leg in a cast, which they may need for up to two months. 

After the pins and cast are removed, the child may need to wear a brace for a year or more to reduce the risk of clubfoot coming back.