Clubfoot/ CTEV: Information for parents

CTEV or Clubfoot:

What is clubfoot?

This is a common congenital (present at birth) anomaly of the foot affecting either or both the feet. It occurs in 1 per 500-1000 births. In this condition, the foot is short and turned and bent inwards and downwards such that the sole faces the opposite leg. Bilateral (both) feet are affected in 50% children. It is more common in boys. The condition may occur in isolation or co-exist with hip or spine anomaly or other systemic disorders.

      

What is the cause of clubfoot?

                The cause of clubfoot is unknown. But researchers have attributed it to smoking, genetic abnormality and environmental factors.

Does it correct spontaneously?

Clubfoot doesn’t correct without treatment. If left untreated, the child will walk on the outer edge of his affected foot with the sole turned inwards. The foot gradually develops callosities (thickened skin overlying the bones) which may be painful and use of normal footwear won’t be possible.

Can my child with clubfoot walk?

                Yes, all children with isolated clubfoot begin to walk at an average of 14 months. 90% of the children can walk without assistance by the age of 18 months.

How is clubfoot treated? 

The diagnosis is made at birth due to the obvious deformity. In the first week of birth, the mother will be taught manipulation of the foot following which the child undergoes manipulation and corrective casting of the affected foot (Ponseti’s technique), once a week by the Paediatric Orthopaedician. The plaster cast extends from the groin to the base of toes. Generally five to six casts are required to correct the deformity, depending on the severity of clubfoot. To ensure complete correction a few children may require a minor procedure called tenotomy wherein the tight heel cord is cut. The surgeon uses a small blade or needle to cut the tightened cord which lies just above and behind the heel. The procedure doesn’t require general anaesthesia and is performed in the OPD room. Following complete correction, the foot will be maintained in another cast for one month. This manipulation requires expertise as faulty manipulation and casting techniques will lead to abnormal appearance of the foot, recurrence, persistence of deformity or other complications.

A type of CTEV splint (Dennis Brown Splint) 

After removal of the final cast, a CTEV brace will be prescribed. The child will be given CTEV brace followed by CTEV shoes. The brace is worn for 23 hours daily for the first three months. The duration is gradually weaned to only night time wear till 3-4 years of age.

Is Ponseti's casting painful?

No, the manipulation and casting doesn't cause pain or discomfort to the baby. Its ideal to perform the manipulation immediately after breast feeding as it keeps the baby remains calm. 

How should I care for the plaster cast?

1.   Always keep the cast in good condition.

2.   Keep the cast as well as the casted limb dry; do not wet it with water/ oil or lotion.

3.   Do not pull out the cotton padding from the splint or cast.

Call your doctor in case of any of the following complications:

·  Baby cries incessantly

·  Fingers or toes are cold and appear white/ bluish.

·  Cast is damaged, wet or cracked.

·  Cast has a foul odor.

Following correction, can the deformity recur?

The deformity can recur in the following cases:

·         Very stiff clubfoot

·         Irregular use of brace

·         Irregular follow up with your Paediatric Orthopaedician

·         Wrong technique of casting

Strict brace wear should be practiced to maintain correction as the foot will otherwise gradually spring back towards its original, deformed position.

What is the success rate with corrective casting (Ponseti technique)?

In children with isolated clulbfeet, Ponseti’s casting has shown good results in 90-98% of children.

Will my child require surgery?

Children with stiff foot who do not respond to Ponseti’s casting or those who present late to the Paediatric Orthopaedician or those in whom the deformity has recurred following initial correction may require surgical correction of the foot. There are various modalities of surgical therapy and these vary on patient to patient basis.

What is the possibility of my subsequent child having clubfoot?

The estimated risk of recurrence in subsequently born children is 3-8% if one child is affected and about 10-30% if the child and one parent are affected.