CLUB FOOT
CTEV – Congenital Talipes Equino Varus
Treatment at the best Club Foot Correction Center in India
PONSETI TREATMENT FOR CLUB FOOT (CTEV) IN OUR CLINIC
Has your baby been diagnosed with a club foot or CTEV (Congenital Talipes Equino Varus)?
Club foot is a birth defect that causes a malformation of the bones, joints and muscles. The foot is twisted inwards and downwards (See Pic C1 & C2). The condition occurs in about 1-4 out of every 1,000 newborns. It is treated shortly after birth with cast correction using the Ponseti method of club foot treatment. We at The Children’s Orthopedic & Spine Care Clinic (COSCC) have been pioneers in the use of the Ponseti technique in India. Since year 2001, Dr Sarup has treated over 1500 children with this condition. All children who have undergone club foot treatment in our clinic have made full recovery. They have no restriction and can play all games, participate in sports activities and dancing. In short, they lead happy, normal lives.
What happens when I get my infant with club foot treated at the clinic?
In order to commence casting, we need the following items to be bought by the parents:
- An age-appropriate soother from a good company (Go to a good chemist or children’s store).
- 1 bottle of White vinegar (Available with your grocer)
- Diapers of the correct size
- Rash free cream (Available at the local chemist)
The plasters are applied as frequently as once in 4 or 5 days. Most infants with clubfoot (Congenital Talipes equino varus) at this age are corrected in 1 month, and usually require 5 to 6 cast changes.
We teach parents how to remove plasters at home in a quick and safe manner.
- It is very important to keep the plasters dry. Do not let the cast be soaked with urine. A plaster that gets wet accidentally must be dried by blowing COLD air by a hair drier onto the wet area. (DO NOT BLOW HOT AIR AS THAT CAN DAMAGE THE SKIN OF THE BABY). A wet cast causes a rash. Sometimes the rash can become so severe that casting has to be abandoned.
- Keep an eye on the toes of the baby. The toes should always be pink in color. Persistent Blue or white discoloration, or marked swelling of the toes, indicates that there is internal swelling of the leg, or that the cast is too tight. Usually, this is accompanied by excessive crying. If this happens, you will need to inform our staff and then remove the plaster at home. You can always bring the baby in next day for a new cast.
- Sometimes, the baby cries excessively at home after the cast has been applied. This can be because the cast can cause an area of excessive pressure on the skin. In this case, the baby will become uncomfortable and may be in pain. If the crying persists for more than 2 hours, let us know and you may need to remove the cast at home. You can always bring the baby in next day for a new cast. This will occasionally happen in the process of infant’s clubfoot treatment.
How do I remove the cast at home?
Take a medium sized basin and fill up to halfway with warm water. The water should be at the same temperature as used for bathing a baby).
Add 2 cups of white vinegar to the water.
Hold the baby in your lap with legs sticking out over the basin. Keep pouring the basin water over the casts for 10 minutes. The cast will get soft. Pluck off the cast end and unwrap like a bandage, pouring more water over drier inside portions as they get exposed.
Wash the legs with soap and water and dry.
Does my child need surgery as a part of CTEV treatment?
At the end of the casting period, our club foot specialists advise most infants undergoing club foot treatment to have a tendon release surgery. This is done at the hospital. The baby is admitted for 4 hours to day care. A local anesthesia or a short general anesthesia is administered. If a general anesthesia is required, it is given with utmost precautions by our highly experienced Anesthesia team. The surgery is done by our club foot specialist very carefully by a 4mm incision. The baby experiences no pain from the surgery.
At the end of surgery, a cast is applied. The cast will be maintained for 1 month. At this stage , the infant’s club foot treatment is completed.
In the postoperative period, sometimes a bloodstain will appear on the cast around the heel area. At times, this will increase over the first day. This is normal and is not a cause for concern.
The baby experiences no pain from the surgery.
In the postoperative period, sometimes a bloodstain will appear on the cast around the heel area. At times, this will increase over the first day. This is normal and is not a cause for concern.
What happens after surgery?
The cast is maintained for a month. At the end of this period, parents remove the cast at home. There is a small adhesive dressing at the back of the heel that must be removed. The leg is bathed with soap and water. The leg is dried by patting down the skin with a clean towel. Moisturizer is liberally applied. The child is taken for measurements for fitting a Dennis Browne Splint. Once the splint is ready, an appointment is made to see the doctor at the clinic. At this stage, exercises are taught to the parents. Our specialized team trains parents in clubfoot physical therapy, which is carried out at home. Physical therapy for clubfoot is done till 7 years of age for best results.
What is the Dennis Browne Splint (DBS)?
The Dennis Browne Splint (DBS) is a boot on both feet connected by a bar. (See Pic). The angle on the boot is preset and depends upon the type of clubfoot. In normal feet and in Atypical Club foot, the angle is set to 50 degrees. In normal clubfoot, the angle is set to 70 degrees. This device is essential for maintaining the correction of your child’s foot.
The Dennis Browne splint is worn day and night for the first 3 months. It is removed for clubfoot physical therapy exercises 6 times a day. It is also removed for bathing. After 3 months, it is worn only while sleeping (Both day and night).
What are the precautions with Dennis Browne Splint (DBS)?
The Dennis Browne Splint is essential for maintaining correction of your child’s foot. Our Clubfoot specialists advise that Club foot relapses in all cases whose parents abandon the use of this splint. We know that it is restricting for children to wear this splint as they get older. Therefore, it is essential to train the child in such a manner that they accept the splint as a part of their normal routine. The DBS is worn for the first 4 years of life.
When wearing a DBS, the feet need frequent careful inspection at the time of physical therapy for clubfoot. Make sure that the skin is healthy and has no areas of breakdown or pressure. If this happens, please get in touch with us at the clinic.
How frequently should I visit the doctor after correction?
You will generally have your newborn with Congenital talipes Equino Varus (CTEV) visit our clinic once in 3 months for the 1st two years, and then once in 4 months in the 3rd year, and then once in 6 months till the child is 12 years of age.
Follow-up is important as it allows us to monitor the feet for any early recurrence.
What happens if there is a relapse?
With regular exercises, and the use of a Dennis Browne Splint – the relapse rate is very low (around 10% in our clinic). This is amongst the lowest relapse results for all CTEV corrections in India.
When we detect an early relapse, we usually review the exercises, or correct a faulty habit (such as noncompliance with wearing a DBS). We may then choose to apply serial casts again. In some children, repeat surgery is required (a tenotomy, or a tendon transfer or both).
Get Answer To Your Most Asked Questions
Can Club Foot be cured or corrected?
We are amongst the best clinics for CTEV correction in India. Club foot can be corrected at any age. The correction is best when the child comes to us at 7 days of age. With increasing age, the correction becomes more difficult
How long does it take to correct club foot?
When a child presents to us in the first month of life, the treatment is completed within 30 to 45 days. We have the best results amongst all the Club foot corrections in India.
Can clubfoot come back?
This is called a relapse. Relapse is seen in approximately 10% cases. The cause often is abandoning the use of a Dennis Browne Splint. Sometimes the club foot is very severe and may come back in-spite of the best possible efforts. However, relapses can be treated very successfully by cast applications, and surgery. The highest chance of relapse is in the first 4 years of life. We have amongst the lowest relapse rates for Club foot treatment in India.
Does club foot affect growth?
The club foot does not affect the length of the limb of the height of a person. In severe CTEV, the affected foot is smaller than the opposite side, and remains so. However, the smaller foot does not cause any physical limitation to the child.
What causes clubbed foot? / What causes clubfoot in pregnancy?
CTEV or Club foot is a common birth defect. It is present in 1 in every 1000 children. The defect is more common in boys. The cause is multifactorial. Genetic defect that develops spontaneously may produce a club foot deformity. A genetic anomaly causing club foot deformity when present in a parent or a sibling may cause a CTEV to develop.
Is Clubfoot a sign of Down syndrome?
No. Club foot is a rarely seen in Down’s syndrome.
What is club foot associated with?
Club foot may be associated with other genetic defects such as Trisomy 18. It may be associated with intraspinal pathology such as a meningo-myelocoele. It may be associated with arthrogryposis, or amniotic band syndrome.
In most cases, the cause is not known.