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Abstract
Treatment in the first few days of life, regardless of severity, should be directed at gently stretching the parts of the foot and ankle that seem to be tight. In general, the cavus and adductus are addressed first, with a counter-pressure being applied over the head of the talus on the lateral side of the ankle. The counter-pressure should be applied to the talus rather than the os calcis, otherwise correction will be prevented. Even a severe clubfoot can be stretched a little, preventing the skin from becoming an extra tether for the deformity and the results of neonatal surgery for clubfoot are either no better or often worse than later surgery.
International Clubfoot Study Group, established in 2003, has approved Kite’s, Ponseti’s and Bensahel’s techniques as the standardized conservative regimes for the treatment of clubfoot all over the world.
The French, or functional method of treatment of clubfoot involved daily manipulation of the child’s clubfoot by the physical therapist for 30 min. This was followed by stimulation of the muscles around the foot, especially the peroneal muscles, to maintain the reduction achieved by the passive manipulation and then, adhesive strapping was applied. The daily treatments were continued for approximately two months and then reduced to three sessions per week for an additional six months. Taping was continued until the patient was ambulatory.
Botulinum toxin in treatment of clubfoot is a method of clubfoot therapy that permits restoration of the normal foot position without requiring surgical intervention. Comprising botulinum toxin derived from the bacterium Clostridium botulinum and cause reversible muscle denervation by blocking the release of acetylcholine at the neuromuscular junction, leading to muscle relaxation.
Having just read about the methods of cast and management with physical therapy of clubfoot, one might logically wonder whether there is still a role for the management of clubfoot with surgery. In more severe clubfeet, Dimeglio grades 3 and 4, and in the syndromic or neuropathic clubfoot, surgical treatment remains necessary in a number of cases.
The timing of surgery is controversial; some surgeons operate between 4 months and 9 months, others wait until 12 months to allow for a good trial of conservative management and foot growth.
Many methods have been recommended for the surgical correction, and can be summarized in the following operations: soft tissue release operations, bony operations, tendon transfer operations and Ilizarov method.