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News Thursday, April 07, 2016

Experts in clubfoot care

Shriners Hospitals for Children — Chicago orthopaedics

Clubfoot is the term used to describe a foot deformity in babies where the foot is abnormally turned inward and downward and held in this position. Clubfoot is caused by genetic and neuromuscular factors that are poorly understood which produce overly tight ligaments and shortened muscles. It is usually diagnosed at birth, though advances in ultrasound technology now allow the condition to be discovered in utero.

Clubfoot occurs in about one of every 1,000 births. Shriners Hospitals for Children — Chicago provided care for nearly 400 children with clubfoot during 2015. While it can be associated with other conditions, most often clubfoot is an isolated diagnosis. It can be worrisome and overwhelming for parents. “Families come to visit. They are concerned. It’s their baby, born with a foot deformity,” says orthopaedic surgeon Haluk Altiok, M.D. Altiok sees patients in a special weekly clinic specifically for clubfoot patients. “There’s a lot of anxiety for parents about their child’s future, whether they will be able to participate in sports and activities. We reassure them that the deformity can be corrected.”
 
Experts say the good news is that clubfoot is very treatable. Treatments may include casting, bracing, physical therapy and rarely surgical intervention. In consultation with their pediatrician, families should be seen by an orthopedic surgeon following birth. Shriners Hospitals for Children — Chicago has designated clubfoot clinics each week, and can prioritize appointments for newborn babies.

The Ponseti method for clubfoot

The staff under the supervision of orthopedic surgeons at the Chicago Shriners Hospital use a conservative approach using the Ponseti method of casting and limited surgery, which our own research shows leads to better outcomes than traditional surgery. “The goal of treatment in clubfoot is to obtain a supple, flexible, functional foot without pain for the child,” Dr. Altiok said. Manipulation, stretching and maintaining position with casting are the guiding principles of this method. Clubfoot correction – straightening the foot-- is obtained gradually and sequentially through weekly repositioning and casting, which should begin when the child is only a few weeks, as the pliability of the soft tissues favors more rapid correction at younger age.
 
“These are weekly cast changes for five to six weeks. After the casting period, most children undergo a same day surgery that involves lengthening the heel cord,” Altiok said. Another important part of the treatment plan is the use of special shoes attached to a brace bar to maintain the correction that is obtained. Typically a child will wear this full-time for two or three months, with subsequent nighttime use for several years Altiok said. “We do this course of treatment because it respects the developing soft tissues, results in less scarring and we see better long-term outcomes for the child.” The Chicago Shriners Hospital offers on-site support services for families including child-life specialists and case managers.  

Though this general outline holds for the majority of patients, changes in the plan may occur after each casting and surgery, depending on the degree of correction obtained.

Leaders in clubfoot research

Clinicians at Shriners Hospitals for Children — Chicago conduct research about clubfoot to gain a greater understanding of both the condition itself and the effectiveness of treatment. Our Chicago hospital conducted a long-term follow up studies of adults who had clubfoot treatment as children. Using our state-of-the-art movement analysis laboratory, the study compared strength and foot pressure while walking. Our research found the Ponseti cast method had better results in adulthood when compared to another treatment known as comprehensive surgical release.

Shriners Hospitals for Children — Chicago has been specializing in pediatric orthopedics for 90 years, regardless of the families' ability to pay. To make an appointment, call 773.385.KIDS (5437). This article is adapted from material that originally appeared in Leaders in Care, our quarterly hospital magazine.