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Clubfoot deformities are far more common then reported.
Reports suggest that clubfeet occur in 1:3000 births; however, these deformities are hereditary and often occur in higher
percentages in regions of the country and higher with some minority groups.
Clubfoot deformities are far more then
just a positional deformity caused by intra-uterine pressure and positioning. Anatomically, the talus bone is abnormal.
The achilles is extremely taut.
Treatment should always begin with serial casting. Over the past 20 years, surgical
techniques have improved. Options for children have expanded exponentially and thus each and every child should be treated
individually. One technique may not be effective for each and every child. One technique that is sweeping the country is
the use of the Ponseti technique. This technique is minimally invasive only involving tenotomy of the achilles. This technique
requires the surgeon to utilize casting as the primary modality for correction. Unfortunately, not every surgeon is as proficient
with casting.
Children with clubfeet can grow up to walk, run and play sports. Some children who have had surgery
have developed serious problems, but are far less common today then even 10 years ago.
Clubfoot-Adult section shows
several case examples. Some good and some bad.
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Typical clubfoot deformity in 4 month old child. Note the creases about the medial ankle, posterior
ankle and midarch. All arise from the equinus, varus position and adducted forefoot. Creases are a bad sign.
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Varus position of the foot
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Isolated metadductus deformity. Often these deformities will be misdiagnosed for clubfeet.
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Severe equinus deformity. This is a case that would have not been a good candidate for a Ponseti
technique. A traditional Cincinnatti approach was used with lengthening of FHL, FDL, posterior tib and posterior ankle and
subtalar capsular releases.
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This foot is after a significant amount of casting. The equinus is the only deformity remaining,
but no amount of casting could correct the equinus. Any attempts of trying to force the foot upward would yield disaster
- flattop talus. Again a Ponsetti would not have worked without developng severe digital contractures.
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As a result of too forceful casting, a flattop talus develops.
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