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Research to advance understanding of congenital condition

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One of the common congenital conditions treated at Shriners Hospitals for Children — Springfield is clubfoot, found in one to two out of 1,000 newborns. Children with this condition are born with feet that are twisted in. Left untreated, this will lead to severe discomfort and disability by adolescence. With treatment, the feet can be pain-free and the patient able to wear regular shoes and have good mobility and function.

Evolving treatment

Historically, the treatment of clubfoot included casting followed by surgery on the tendons around the foot and ankle. However, disappointing long-term results have been reported for this surgery, including pain, functional limitations, stiffness, weakness and premature arthritis.

Over the last 15 years, the preferred treatment method for clubfoot has changed significantly. The Ponseti technique involves a series of plaster casts, typically changed on a weekly basis in order to gradually correct the deformity. With this method, the need for surgery is limited, and when necessary, it is usually less involved than the complex procedures used in the past. In long-term follow- up, excellent or good outcomes using this treatment have been reported in more than 80 percent of cases.

Once the deformity has been corrected with casting, orthopaedic shoes connected by a bar are used to help maintain the adjustment. These are typically worn all the time for the first three months, then at night and during naps until the child is 3 years old. Surgery may sometimes be necessary for older children (ages 3 to 5) who begin to walk on the outer border of the foot.

New research will lead to new understanding

In collaboration with researchers from the University of Massachusetts and Connecticut Children’s Medical Center, Shriners Hospitals for Children — Springfield s studying the long-term effects of Ponseti casting and comprehensive surgery on foot function.

During this study, adolescents and young adults who received treatment for clubfoot as children will be evaluated in a motion analysis laboratory. Evaluation will involve a detailed assessment of foot biomechanics, pressure under the foot while walking, activity level in daily life, and patient-reported pain and quality of life. It is anticipated that this research will provide a significant advancement in the understanding of foot function after treatment of clubfoot.