What is clubfoot disease?

Equine foot, better known as clubfoot, is a congenital deformity that can be diagnosed in the ultrasound of the 20th week of pregnancy, although the diagnosis is confirmed visually after birth by the specialist. We tell you what types there are and what is the most recommended treatment.

Clubfoot, also more commonly known as clubfoot, is a congenital deformity in which the foot or feet are turned, that is, turned downward, and facing inward. The frequency with which it appears is 1 per thousand children, and 50% is usually bilateral (in both feet). The equine foot is made up of four deformities. It is a clubfoot, cavus and adductus, and it is a congenital deformity. The main deformity and the one that is found in all club feet is the equinus, which is a shortening of the Achilles tendon.

The cause is unknown, but it is associated with hereditary factors, that is, in families where there is a member with clubfoot, there is a greater probability of having a child with clubfoot, especially if both feet are affected (bilateral). Another risk factor is smoking, and there are studies that associate it with a greater risk of clubfoot, and it is also more frequent in males, although there are cases in which the mother he has never smoked, there are no cases in the family and the child is born with a clubfoot.

Types of clubfoot

As it is a congenital deformity, clubfoot presents from birth and, according to studies, it shows denser and more rigid tendons on the posterior and inner side of the leg. All this causes progressive deformities to be triggered in the fetus throughout the pregnancy. Its diagnosis is usually possible thanks to the ultrasound that is performed at week 20 of gestation and is confirmed visually after birth, since it is not possible for the baby to maintain a normal foot position.

The clubfoot, as such, is a foot where there are different degrees of severity, but it is always characterized by having the Achilles tendon shortened, that is, by being a foot equine. There are very rigid and deformed, and others lighter. The structured congenital clubfoot is a rigid foot that needs treatment, the best treatment according to scientific evidence being the Ponseti method.

Then there is the postural or positional clubfoot, which are those feet with a slight deformity that occur in those cases of first-time mothers with a smaller uterus, twin births or because the baby is large and the feet acquire this position in the uterus due to lack of space, producing a slight deformity after birth, but they do not usually need treatment, since they are usually reversible.

How to treat clubfoot varus?

It is recommended that the treatment be carried out as soon as possible to obtain better results, that is, experts advise starting from the first days of life once diagnosed by a child traumatologist, previously referred by the pediatrician. The most classic and ancient treatment is the one carried out with surgeries with regular results. There are other treatments that consist of daily stretching, with bandages. But the world-renowned treatment with the best results is the Ponseti method.

This treatment must be carried out by experienced professionals because these are cases that, if not corrected properly, can leave children with lifelong deformities. With inadequate treatment, children can develop lifelong disabilities or foot problems that require multiple surgeries, which is never a good thing in the long run.

The Ponseti method is a treatment devised by the Mallorcan doctor Ignacio Ponseti, who died in 2009: It has proven to be the least recurrent, that is, the one that has presented the fewest cases of reappearance of the deformity and with which children hardly need surgeries. The treatment will depend on the severity, as well as the reappearance of the deformities, therefore, it is very important to correctly comply with the guidelines of said method.

What is the Ponseti method?

This treatment consists of a series of gentle manipulations in order to obtain the best possible alignment, maintaining that position with a plaster bandage. First we correct the cavus, then we correct the varus and adductus (with several casts), and then the equinus is corrected, which is the shortening of the Achilles tendon. This correction is done with a small surgery where a cut is made in said tendon that is later glued back on and, with this, we get the foot not to be downwards, that is, it is not in equinus, but rather its length is acquired. This surgery can be done in the operating room with general anesthesia, but the most widespread today is to do it with local anesthesia to avoid subjecting the child to general anesthesia with possible neurological repercussions.

After the intervention, it will be necessary to replace another cast for about three more weeks, due to the tendency of the deformity to reproduce. Once we remove the last plaster, the Ponseti method is maintained, approximately, until the age of 4, during which the child must wear some devices, which are boots with a bar that joins them, and that keep the feet in the correct posture.

There are cases in which the revisions must be closer because some feet present deformities again. The feet that present this deformity again can be due to various reasons: the foot is very severe, the treatment has not been correct, or the family has not strictly complied with the use of corrective boots. And it is that the child must sleep with the splints until he is 4 years old. But at the same time, in cases in which the parents have carried out the treatment in a very regulated way, the results are very good.