Clubfoot - CTEV

It is the most common congenital deformity of the foot that affects a child’s muscles, bones, tendons, and blood vessels. In this condition, the affected foot’s front part turns inwards with the heels pointing down.

Many parents discover their child has Clubfoot or CTEV (Congenital talipes equinovarus) during prenatal ultrasound weeks or months before the child is born. When the child is born, the deformity is evident and treatment can be started within first week after delivery.  

Types of Clubfoot

Idiopathic Clubfoot: This is a more common form. The Clubfoot, in which no other medical problems are associated, is called idiopathic CTEV. The term idiopathic denotes that the cause is unknown.

Non-isolated Clubfoot: It is a condition that develops secondary to other various underlying conditions or neuromuscular disorders, like arthrogryposis, spina bifida etc.

Symptoms of Clubfoot 

These are the signs one usually notices in the feet of babies with Clubfoot

• Deformity in the foot, with the top of the foot twisted downward or inward 
• A deep crease is seen on the bottom of the foot
• It is arched higher than usual
• The affected foot or leg may be slightly shorter
• The foot may appear as if it is upside down

Without treatment, the child may:

• Develop calluses that are painful
• Be unable to wear shoes
• Have painful feet that will severely limit activity
• Walk on their foot’s outer edge instead of the sole

Treatment Process Under Dr. Somesh

If ignored, Clubfoot can lead to serious health issues like arthritis and problems related to walking adjustments made by the child, like sores or calluses on the feet. Untreated or partially treated Clubfoot severely affects the walking capacity and pattern of the child.

So, if you notice signs of Clubfoot, bring your child to our clinic for a full evaluation. With our experience in such paediatric orthopaedic cases, we immediately confirm if your child has Clubfoot or not.

We usually begin treatment as soon as possible after assessing the child’s current medical condition since the baby’s tendons and joints are very flexible at this young age, and we can utilise that flexibility for the correction of the deformity.

Our treatment methods include:

Ponseti method: It is the most common and effective treatment for Clubfoot. It involves using a series of casts to gradually move the baby’s foot into the correct position. The foot has to be rotated externally until it turns out 60 to 70 degrees.

• Treatment stage: In this stage, we reposition the child’s foot with a series of casts. We stretch and reposition the foot and then place the foot, ankle, and leg in a cast to keep the foot in the new position. After a week, the cast will be removed, and we will again reposition the foot. Then, a new cast will hold the foot in its new position. This process has to be repeated till the child’s foot moves to the correct outward position. After 5-7 casts, most children will need percutaneous tenotomy in which the tight tendon of the heel (Tendo-achilles) is lengthened by a very small cut.
• Bracing stage: The child is provided with braces to keep the foot in the correct position. The brace has to be worn around 22 hours a day during the initial stage and later on about 14 hours a day. Braces are the best way to prevent the foot from turning inward again. 
• Exercises: A home-based exercise regimen will be taught to parents to help strengthen the muscles and maintain their position.

Surgery: Surgery is suggested only for older children with relapse/recurred CTEV. It is done to ease the foot into a better position. The surgery aims to adjust the foot and ankles' tendons, ligaments, and joints.

Less extensive surgery targets only those tendons and joints that are contributing to the deformity, lengthening the affected tendons and/or transferring other tendons. Major reconstructive surgery involves releasing multiple soft tissue structures like ligaments and tendons with bony surgery, which is needed in relatively older children.

After surgery, the child may need to wear a cast for around 4-6 weeks. Mostly, special braces may also be needed for a few months after the surgery.

The main goal of treatment at our clinic will be to change how your child’s feet look and function before he or she starts walking, thus preventing potential disabilities in the long run.

Through our compassionate care and guidance with experience in treating Clubfoot, we ensure that your child lives a fully active life and is able to wear ordinary shoes.