As such in many cases there is no associated or underlying cause. Many theories are proposed for the cause, It can be a packaging defect, genetic disorder, or hereditary from the maternal or paternal side. Neurogenic conditions like spina bifida and cerebral palsy may also lead to clubfoot-like deformity.

You should not feel distressed about knowing the fact that your unborn child has clubfoot. Meet an expert pediatric orthopedic surgeon to know about the condition and treatment plan. He/ she may guide you to consult a fetal medicine expert if any syndromic association is suspected.

Congratulations first of all about the great news.

Be assured that clubfoot is a completely treatable condition if the right treatment is initiated at the right time. And the Right time is now just when your child arrives in this world. Yes, you read it right. Treatment of clubfoot can be and should be initiated as soon as possible after birth, be it the 1st day of life. Until and unless the child has some critical issue to settle or he is in NICU the treatment can be started within the first few hours of life. Sooner the better, because the soft tissue a quite supple and easily manipulatable in the early days of life so the treatment response is quicker.

Don’t worry about it, if due to certain circumstances the child cannot receive treatment in the first few weeks of life it won’t have negative implications on the child’s life or prognosis. Just that, delayed treatment may lead to soft tissue stiffness and it might require a few more casts to correct the deformity.

Your worries are absolutely correct and as expected from any new parents especially those who are in a nuclear family. But take my word, every kid more brave and strong than your expectations. They always amaze us by copping up with every odd situation they face. In my experience, none of my patients had any issues with early treatment. Instead, many of them responded so well that the almost mandatory surgical procedure ( TendoAchillles tenotomy) was not needed in a few of them.

Congratulations on making the decision to start your Ponseti treatment journey so early. It’s a good decision to start the treatment with 1st few days of life. The benefits of early treatment are

1. The child responds well to treatment as soft tissue is really supple and joints are easily manipulated.
2. Fewer casts may be required to achieve complete correction
3. The need for tenotomy may be obviated.
4. As every child with Ponseti treatment protocol needs bracing for a long time, the need for full-time bracing (23 hours a day) passes off when he/ she is too young, so it doesn’t hamper the child’s growth and development. All his/ her milestones will be achieved normally.

Ponseti method is the method of serial manipulation and casting. Most of the correction is achieved with just manipulations and plasters and if at all any surgery is required is just a percutaneous tenotomy of the Achilles tendon. That’s why it is called as Conservative treatment of clubfoot. On the contrary, in the past days before to invention of the Ponseti technique a major surgery where complete soft tissue release was being done regularly under general anesthesia with a big surgical incision.

So, typically when a child with clubfoot is being treated by the Ponseti method, the casts will be changed at weekly intervals. On average 5 casts will be needed before tenotomy. A dafter tenotomy final casts will be required which is for 3 weeks duration. So a total of about *8 weeks ( 5 weeks for cast + 3 weeks of tenotomy ) will be the duration for which one has to wait for complete correction of the deformity.

Also please be aware of the fact that Ponseti treatment is broadly divided into 2 phases

Phase I is the stage of correction or corrective phase where you need to visit the Doctor and the doctor will apply the casts and that’s all.

Phase II is the stage of maintenance of correction or maintenance phase, which I call a phase of great parental care where Parents have to play a very active role or parents have to behave like a Doctor and deliver the treatment. To maintain the correction parents need to put their child into Braces ( FOOT abduction braces or Dennis brown Splints of Steenbeck braces) as per the Doctor’s instructions. Also, they need to devote some time to stretching and exercises for every brace-free hour.

Well Congratulations for undergoing correct treatment at right time. It is crucial to start treatment early. Now as you have already got the correction and now maintaining that correction with DB splints. We have a set protocol for maintaining the braces.

For 1st 3 months after correction, DB splints have to be maintained for 23 hours per day after these 3 months the bracing time can be reduced to 12- 14 hours a day i.e. During Nights and Naps one has to wear the splints. That’s what medical literature has said.

But here come the recommendation from my own experience and also many of my pediatric Orthopaedic Colleagues. I recommend decreasing the brace wear time gradually after 1st 3 months for 23 hrs./day.
4th month 22 hours/day
5th month 20 hours/ day
6th month 18 hours/ day
7th month 16 hours/ day
8th months onwards 12-14 hours/day (i.e. Night and Nap time wear of the brace)

You need to follow this night and naps brace time schedule till 4 years of age. After 4 years of age/ Brace time wear chances of relapse are very less. Only stretching and exercises can be continued daily.

That’s a great question. After complete correction, one may feel that it’s not necessary to visit the doctor again and again. But to tell you the truth from our own experience those parents who don’t come back on time for follow-up are actually ignorant about the brace wear time also. They are kids who have the highest chance of relapse. We recommend a fixed follow-up schedule which is as follows.

Follow-up schedule after Clubfoot correction

1. 1st month after correction every 15 days visit to the doctor.
2. Next 3 months Monthly Visits, every month.
3. 4 months onwards 3 monthly ( Quarterly) visits for the next 1 year.
4. After 1 year if the correction is very well maintained and the child is functionally doing well Doctor may ask you to visit only once in 6 months i.e. half yearly visits till 4 years of age.

Follow-up visits are important to keep you disciplined about the bracing protocols and to detect early signs of relapse of clubfoot. If relapse is detected early the treatment is easy.

Although relapse has to diagnose in consultation with the treating Doctor, you look for certain symptoms which can tell you about relapse.

While making the child wear Braces if you feel that the heel is not Touching the sole or repeatedly foot is coming out in spite of adequately tight shoe straps, you must consult your doctor. When the clubfoot child has started walking, notice his foot progression angle or notice the great toe. If the Foot/ great toe is pointing inwards and there is a high medial arch or the heel is not touching the ground or the heel is tilting inwards. All these indicate a relapse of clubfoot.

You can also notice that the inner side of the chappal at the heel gets torn before the outer edge.