If your baby has club foot, treatment will usually begin within a week or two of their birth. The aim of treatment is to give your baby pain-free and functional feet.
A technique called the Ponseti method (named after Dr Ponseti who developed it) is the main treatment for club foot. An increasing number of orthopaedic specialists (bone specialists) use the Ponseti method and it is available in many clinics. However, not all hospitals provide the service.
The Ponseti method is successful in treating more than 8 out of 10 cases of club foot. Long-term results are also very promising compared to previous surgical treatment methods.
One long-term study followed up people with club foot who had been treated with the Ponseti method 30 years ago. Over three-quarters of the people who were treated either had good or excellent function in their feet. This was only slightly less than a group of people of similar ages who were questioned about pain in their feet and had never had club foot.
The Ponseti method
The Ponseti method involves weekly sessions with a specialist, or another trained healthcare professional, who will manipulate your baby's foot with their hands, gradually correcting the bend in their foot. 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 corrected a little more each time. On average, five or six casts are usually used, but your baby may need to have a few more or a few less, depending on the severity of the condition.
Your baby's foot will be manipulated gently, so the procedure should not hurt them. Babies will often cry during manipulation and casting although it is not usually due to pain.
Achilles tendon surgery
Following the Ponseti method, your specialist will decide whether your baby needs to have a small operation to release the tight tendon at the back of their heel (the Achilles tendon). This is a very minor operation that most babies with club foot will need to have.
Achilles tendon surgery is often recommended after the front of the foot has been corrected (usually after the fourth or fifth cast) but when the ankle cannot be fully corrected.
The procedure is usually carried out under a local anaesthetic on an outpatient basis, which means that your baby will not have to stay in hospital over night. In some cases, a general anaesthetic may be used so that your baby will be unconscious during the operation.
During the procedure, the surgeon will make a small cut in your baby’s heelcord to release their foot into a more natural position. Your baby’s foot and leg will be put in a plaster cast for about three weeks.
A small number of children will require further surgery when they are between two and seven years of age. This may involve moving a tendon in front of the ankle to a different position to improve the foot’s function.
Boots and bar
After your baby’s foot has been fully corrected they will need to wear special boots that are attached to a bar (brace). This will hold their feet in the most effective position. The boots have straps to attach them firmly to your child’s feet and the bar will keep their feet about shoulder distance apart.
The boots will need to be worn 23 hours a day for three months, and then after this time just at night and nap times until your child is about four years of age.
It is very important that your child wears the boots for the required amount of time otherwise their foot may return to how it was previously and treatment may have to begin again.
Relapse
Sometimes, club foot can reoccur. This is known as a relapse and it is estimated to occur in 1-2 out of every 10 cases. Relapses are more likely if the treatment method described above is not followed exactly.
If club foot reoccurs, your child may need to repeat some of the treatment stages – for example, they may need to have their foot manipulated again and put in a cast.
In some cases, ensuring that your child continues to wear the boots and bar may be enough to correct their club foot. However, in other cases where there has been a relapse, surgery may be required.
