Know About Clubfoot | Dr. Sudhanshu Bansal | Paediatric Orthopaedic Surgeon in Punjab

Today we will talk about clubfoot or C.T.E.V foot deformity.

Why it is called clubfoot because it resembles the shape of a golf club.

When any patient comes to us with an ultrasound with clubfoot documented. They must consult with a sonologist and obstetrician, to see for any anomalies, and if in doubt can get a genetic evaluation.

Various types of clubfoot. The positional type is the only type that can be corrected with exercises. Other types are idiopathic and non-idiopathic/ atypical types.


Atypical may be associated with some conditions such as DDH, spinal issues, arthrogryposis etc. Atypical also needs more cast, and more effort to correct the
Deformity.

When to start casting, as early as possible. But considering the weight, maturity and skin condition of the child. We do serial weekly cast to correct the deformity, usually, 5-6 cast is required to correct the deformity.

We require to do surgery, tenotomy of tendon Achilles/ heel cord in most of the kids, after tenotomy the last cast is given
. After the correction is achieved we do bracing for both feet, it has a bar and shoe.


The bracing protocol must be followed religiously, it starts with 22 hours a day and eventually reduces to sleep time. Bracing has to be done up to 4-5 years of age.

Day shoes are only given to kids who have a tendency to recur, resist correction, or any anomalies associated with CTEV deformity. Even for kids who are very irritable, and not compliant with bar shoes, in them, we may need to give separate shoes.


In a few kids, we may need to do tendon transfer for flexible deformity which is called dynamic supination deformity.

Other than this, for kids who are neglected, we may need to do surgery for them with release or in very severe cases external fixator-assisted correction is done.

Braces have to be worn until 4-5 years of age, doesn’t matter
where treatment is taken, protocols are the same. It is very important to strictly follow protocol related to brace, exercises, and follow-ups because this is not one time
treatment. Many kids whose parents follow all instructions religiously get the best results.

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