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Clubfoot

 



One out of every 1,000 babies is born with a clubfoot deformity. The male-to-female ratio is 2:1, and both feet are involved 30 to 50 percent of the time. A clubfoot is apparent at birth and may even be found on a prenatal ultrasound examination. A clubfoot has all the following features: adduction - or inward turning - of the metatarsals, varus - or inversion of the hindfoot, equinus - or plantarflexion - of the ankle, and cavus - or high arch - of the forefoot. Generally, these abnormalities are rigid to some degree. Although a clubfoot can sometimes appear in association with another condition, most of the time it occurs in otherwise normal, healthy infants. The cause of clubfoot remains unknown.


How is clubfoot treated?
In the 1970’s through the 1990’s many doctors used surgery to correct clubfoot deformity. By releasing ligaments and tendons, doctors placed the immature foot into a more normal position. Often, the initial appearance of the foot was much improved. Unfortunately, over time, many of these feet became painful and stiff by the time the patient reached adolescence.

Ponseti Minimally-Invasive Method
More recently, a minimally invasive treatment method has gained wide attention. Because this technique corrects the foot without the need for extensive releases, there is less scarring and stiffness. The treatment—developed by Ignacio Ponseti, MD, a professor emeritus at the University of Iowa—has been successfully implemented at several centers worldwide.

What does the Ponseti method entail?
The Ponseti method involves a series of specific manipulations and cast applications performed weekly for 4 to 6 weeks. At the end of that period, the patient undergoes a small surgical procedure—called a tenotomy—to lengthen the heelcord. Following the tenotomy, a cast is worn for an additional 3 weeks. After correction of the foot is achieved, a special post-corrective brace is worn for 23 hours a day for 3 months, and then at night and naptime to prevent the deformity from recurring.

Why would I choose the Ponseti Method?
Because the Ponseti method does not disturb the joints of the foot and ankle, long-term studies have shown that this technique lessens the risk of stiffness and scarring of the foot, pain, and muscle weakness that may occur following extensive clubfoot surgery. However, the Ponseti method is not a “quick fix”. It requires a team effort to achieve a successful outcome, involving the parents, physician, nurse coordinator, cast technician, and orthotist.

Orthopaedic Institute for Children Clubfoot Clinic
The Orthopaedic Institute for Children (OIC) Clubfoot Clinic, under the direction of Lewis E. Zionts, M.D., is dedicated to the treatment of newborns and infants with congenital clubfoot deformity. Dr. Zionts learned the technique from Dr. Ponseti and was listed by Dr. Ponseti on his webpage as one of the U.S. physicians qualified in this technique. Dr. Zionts is currently listed as a preferred provider on the Ponseti International Association website. Visit the Ponseti International Association website.


More About Clubfoot:
Lewis E. Zionts, M.D.
UCLA Department of Orthopaedics, Lewis E. Zionts. M.D.
Clubfoot Information for Parents