Club Foot

Clubfoot is one of the most common congenital orthopedic anomalies and was described by Hippocrates in the year 400 BC. The equinovarus deformity is classified into congenital and acquired. The congenital is further classified into idiopathic and non-idiopathic types. The idiopathic type is typically an isolated skeletal anomaly, usually bilateral, has a higher response rate to conservative treatment and a tendency towards a late recurrence. The causes of the non-idiopathic type include deformity occurring in genetic syndromes, teratologic anomalies, neurological disorders of known (e.g., spina bifida) and unknown etiology and myopathies. The non-idiopathic type is characterized by diametrically opposite deformities in the feet (calcaneovalgus in one foot and equinovarus in the other), presence of other anomalies and a poor response to conservative or operative treatment. Acquired equinovarus has neurogenic causes (e.g, poliomyelitis, meningitis, sciatic nerve damage) and vascular causes (Volkmann Ischemic Paralysis). The number of children born with the clubfoot in Singapore is 64 per year. The number is not increasing year by year. This is not a good sign. A technique called the Ponseti method is the main treatment for club foot, as it has been shown to be more effective and have better long-term results compared to the operations used in the past. The number of persons enrolling for the disease is not increasing year by year. The Ponseti method involves weekly sessions with a specialist, who will manipulate your baby's foot with their hands to gradually alter the bend in it. They will then apply a plaster cast from your baby's toes to their thigh to hold the foot in its new position. The casts will be changed weekly at each session, and your baby's foot will be altered a little more each time. On average, five or six casts are used, but your baby may need to have a few more or a few less, depending on how their club foot is. The procedure shouldn’t hurt your baby, as it’s a gentle manipulation. Babies often cry, but it isn’t usually due to pain.

Major research is going on in Clubfoot through Ponseti method and French Functional Method. Many scientists compared the Ponseti and French functional method for idiopathic clubfeet (265 feet [176 patients] by Ponseti method; 119 feet [80 patients] by French functional method). The study showed that although there was a trend toward improved results with the Ponseti method, the difference was not significant. Parents chose the Ponseti method twice as often as the French functional method. Initial correction rates were 94.4% for the Ponseti method and 95% for the French functional method. Relapses occurred in 37% of the Ponseti-method feet, and in a third of these cases, further nonoperative treatment was successful; however, surgical treatment was necessary for the other two thirds. Relapses occurred in 29% of the feet treated by the French functional method; surgical intervention was necessary in all those cases. At the latest follow-up, outcomes with the Ponseti method were good in 72% of cases, fair in 12%, and poor in 16%. For the French functional method, outcomes were good in 67%,fairly 7%,and poor in 16%.