Clinical Research on Foot & Ankle
Open Access

Clubfoot is a congenital disorder, in which one or both feet are rotated in and out. Without treatment, the foot remains paralyzed, and people walk on the sides of their feet. Early treatment is usually done in a way that repairs the birth defect without undergoing invasive surgery. This includes moving the foot to an improved area followed by a stream, which is repeated at weekly intervals. Once the internal bend is developed, the Achilles tendon is usually cut, and the bases are worn for up to four years. Without treatment it can cause calluses, foot infections and difficulty getting into shoes, pain, difficulty walking, and paralysis. What is thought about the exact cause of a joint foot varies, but genetics, environmental factors, or a combination of both is involved. Research has not identified a major cause, but many results agree that there may be more than one cause and at least in some cases a phenotype may occur as a result of the effects of various factors working together. Factors used to test for stiffness include stiffness of the limbs, presence of skin ligaments in the arch and heel, and instability of the muscles. In some cases, it may be possible to detect a foot injury before birth using ultrasound. A prenatal ultrasound scan can allow parents to learn more about the condition and plan treatment after the birth of their baby. The Ponseti method includes serial casting where the foot is handheld in an advanced position and held in place with a long leg made from toes to the thigh. The following characters are used after stretching the foot by focusing on the front grip with posterior pressure on the talus, bringing the navicular laterally and improving the alignment of the talonavicular joint. By the end of the serial cast, many children have repaired the cavus, adductus and varus deformity, but continue to have equinus deformities. To correct this, a procedure called the Achilles tenotomy is performed. Prior to the procedure, many institutions place the child under sedation or supervised anesthesia care, although Ponseti recommends using only local anesthesia. Next, the area around the heel is cleansed and numb, and a small scalpel is used to cut the Achilles tendon. The incision is small so there is little bleeding and no needed for stitching. The skin is covered with a thin coat, and the foot is placed in the last leg of the long leg in a fully prepared area. The most common reason for this is inadequate adherence to steel, such as poorly worn foundation, poor maintenance time, or poor use of it daily. Children who do not follow proper bracing rules have a sevenfold repetition rate than those who follow the bracing protocol, as the muscles around the foot can return it to a normal position. Repetition is most common if you do not follow the bracing properly, as the muscles around the foot can pull you back into an abnormal position. The low level of parental education and failure to understand the importance of commitment is a major cause of non-adherence. Recurrent feet may also require additional, extensive surgery and have a reduced chance of receiving subsequent correction. The French method is a conventional, non-invasive approach to clubfoot treatment that involves daily physical therapy for the first two months followed by weekly physical therapy three to four months and continuous home exercise after the completion of formal physical therapy. During each physical therapy session the feet are used, stretched, and then recorded to maintain any gains made in the foot list movement. In feet with partial correction with non-invasive treatment, surgery may be less severe and may involve the back of the foot and ankle. This is done using a small incision and may involve only loosening the posterior capsule of the ankle and subtalar joints, as well as extending the Achilles tendon. Surgery leaves a residual scar and often has more strength and weakness than non-surgical treatment. As the foot grows, there is a chance of uneven growth which may result in recurrence of a deformity that may affect the forefoot, midfoot, or hindfoot. Most patients do well, but some require orthotics or additional surgery. Long-term studies of adults with postoperative clubfeet, especially those who require major surgery, indicate that they may not perform well over time. Some people may need more surgery as they grow older, although there is some discrepancy in the operation of such surgery, due to the proliferation of red tissue present from previous surgery.

The authors are grateful to the journal editor and the anonymous reviewers for their helpful comments and suggestions.

The authors declared no potential conflicts of interest for the research.