Definition & Overview
The application of clubfoot cast with moulding or manipulation is part of treatment for clubfoot. Clubfoot is a condition wherein the foot and ankle are twisted permanently. It occurs when the tendons and ligaments holding the bones and muscles together are too tight, keeping the foot in an abnormal position. Clubfoot is a congenital deformity, which means it presents at birth. Since it is diagnosed right after birth, even infants can begin treatment. Part of this treatment is to place the foot in a cast. If began early, treatment is often successful.
Who Should Undergo and Expected Results
The application of clubfoot cast with moulding or manipulation is beneficial for patients who suffer from clubfoot. Clubfoot, or the permanent clubbing or twisting of the feet and ankle, is a congenital and hereditary defect that some babies are born with. It is also known as talipes equinovarus. It is more common among males, and has been linked with:
- Spinal cord deformities, such as spina bifida
- Smoking during pregnancy
- Baby’s position in the uterus
- Neuromuscular disorders, such as cerebral palsy
- Oligohydramnios, or low levels of amniotic fluid around the foetus during pregnancy
The two primary treatment options for clubfoot are:
For infants born with the condition, there is still a good chance of putting the feet and ankles back in the correct position without the need for surgery. This is why casting is performed. However, it is not always effective or sufficient. Casting is usually only successful in the following circumstances:
- When clubfoot is only mild
- When treatment begins within the first two weeks of birth
- When the Achilles tendon is not too tight or does not need to be released (if the patient’s Achilles tendon is too tight, it has to be released through surgery)
If casting is not performed early or if it has proved unsuccessful, the patient’s only other choice is surgery.
After a clubfoot cast is used, it is still possible for the problem to return. Such relapses occur in one out of every ten cases of clubfoot. In the case of a relapse, it is still possible to put the foot in a cast again to re-manipulate it. Sometimes, however, patients are left with no other choice but to undergo surgery.
On the other hand, if the clubfoot casting proved successful, patients can expect to regain or achieve proper function of the feet.
How is the Procedure Performed?
There are many casting techniques used. The most common is the Ponseti method, which was named after its developer, Dr. Ignacio Ponseti. This method has been shown to be more effective. Studies show that it produces better long-term results compared to other existing methods. It works by gradually manipulating the baby’s foot into a normal position. This requires the use of a cast.
The Ponseti method involves casting and manipulation. The application of the clubfoot cast involves the following steps:
- The doctor gently stretches the foot into a normal position as much as possible.
- The foot is wrapped, and the cast is secured in place. The cast can either be a long or short leg cast.
- After a few days or weeks, the foot is stretched further towards a normal position.
- The cast is then placed back.
- This process is repeated until a normal position is achieved.
Doctors use two kinds of casts; the short leg and the long leg cast.
- Long leg casts cover the entire leg from the upper thigh down to the foot.
- Short leg casts cover the area below the knee down to the foot.
The whole treatment may take six to eight weeks. The patient has to visit the doctor at least once each week, during which the cast will be changed. Over the course of treatment, around five to six casts may be used depending on the severity of the condition. After treatment, patients are given a foot bar, heel cord, or splint to maintain the foot’s position. They may also be given special shoes.
The application of clubfoot with moulding and manipulation is not a painful procedure because it manipulates the feet gently. Thus, it is safe and effective even for babies.
Possible Risks and Complications
Patients who undergo clubfoot casting with moulding or manipulation are at risk of:
- Recurrence or relapse – To keep the foot and ankle from twisting again, the patient is asked to wear foot braces. These should be worn 23 hours a day for three months. These also need to be worn at night for up to 4 years.
- Nerve damage in the foot
- Blood flow problems
- Wound healing problems
Casts also carry a set of risks, including:
- Skin irritation
- Skin infections
- Heat injury
- Pressure soles
- Joint stiffness
Anand A, Sala DA. “Clubfoot: etiology and treatment.” Indian J Orthop. 2008 Jan-Mar; 42(1): 22-28. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759597/
Nordin S, Aidura M, Razak S, Faisham WI. “Controversies in congenital clubfoot: Literature review.” Malays S. Med Sci. 2002 Jan; 9(1): 34-40. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3436098/