Method Corrects Clubfoot, Sparing Infants Surgery

Clubfoot may be correctible without surgery in up to 90% of affected infants, potentially sparing them the pain, complications and expense of traditional treatment.

The clubfoot deformity affects 1 in 750 to 1 in 1,000 babies, most frequently boys. They are born with one or both feet turned inward and pointed downward because of a tight, shortened Achilles’ tendon.

A drive to keep babies out of the operating room pushed some foot specialists to revisit a nonsurgical technique developed at the University of Iowa by Dr. Ignacio Ponseti more than 50 years ago.

The Ponseti method, which involves gentle manipulation of the leg followed by casting with thin plaster, can correct the problem as well as surgery in 90% of affected babies, said Dr. Robert W. Mendicino, president of the American College of Foot and Ankle Surgeons, the professional organization of podiatric surgeons.

Avoiding foot surgery in infancy also potentially spares the child repeated corrective procedures later on, Mendicino said in an interview.

“The average person who has clubfoot surgery ends up with two to three surgeries by the time they get to [their teens and 20s] and end up with these really rigid feet,” Mendicino said.

But Mendicino said podiatric and orthopedic surgeons are finding that the Ponseti method yields a proper correction in the vast majority of cases.

Researchers at Kaiser Permanente Medical Center in Walnut Creek have documented its success in a study of 29 infants treated with the method after other nonsurgical approaches proved ineffective. Clubfeet in all but one of the infants were corrected with the manipulation and casting, according to results presented this past week at the podiatric group’s annual meeting in Los Angeles.

Here’s how the technique works:

Doctors see the child several times in two to three months, each time stretching and manipulating the affected leg for 10 minutes before covering it from groin to toe with two sections of cast. Every five to seven days the process is repeated, with total wearing time typically six to 12 weeks.

Then the doctor usually makes a simple incision that releases the shortened Achilles’ tendon, which nine times out of 10 isn’t released by the casting alone. The tendon usually heals and reattaches in two to three weeks.

This is a minor office procedure, requiring only local numbing and a single stitch, compared with more extensive clubfoot surgery that involves general anesthesia, major incisions and longer recovery, Mendicino said.

Next, the child is fitted with a pair of special shoes separated by a metal bar to maintain the correct foot position. Those are worn day and night for three months, and at night until about age 4, Mendicino said.

Although the method takes patience and expertise, it is less risky and less costly than surgery. Clubfoot operations typically run $3,000 to $5,000, while the casting runs about $1,200, with an additional $50 for each set of shoes and another $50 for each bar.