Correcting Clubfoot Without Surgery

The deformity known as clubfoot can be corrected successfully without surgery in 90% of infants, according to research presented at the annual meeting of the American College of Foot and Ankle Surgeons in Los Angeles (ACFAS, CA, USA).

An external manipulation and casting technique, called the Ponseti method, is gaining acceptance by foot and ankle surgeons as an alternative to clubfoot surgery. In a paper presented at the meeting, researchers from Kaiser Permanente Medical Center (Walnut Creek, CA, USA; www.kaiserpermanente.org) evaluated 29 infants with 47 clubfeet who were treated with the Ponseti method. All but one were corrected and did not require surgery. In the Ponseti method, gentle stretching and manipulation are performed for about 10 minutes on an infant's foot, followed by the placement of thin plaster casts that are changed every five to seven days. These extend from toe to groin in two parts. Most clubfeet are corrected with five or six castings within two months.

Afterward, infants wear a special straight-last shoe with a bar affixed to the bottom that rotates the foot away from the body to preserve the clubfoot correction as the infant's foot develops. The special shoe should be worn until the child begins to walk. Also, a simple in-office procedure is usually performed to release the Achilles tendon.

"It has not been widely published that nonsurgical treatments can achieve permanent correction in the first year of life,” said Robert W. Mendicine, D.P.M., president of ACFAS. "For the best long-term outcome, casting should begin immediately after birth.”



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