Posted by Claudia Grazioso on May 19, 2011
Congenital Talipes Equinovarus (CTEV), also know as clubfoot, is one of the most common birth defects in the United States, occurring in an estimated 1 out of every 1,000 newborns. This birth defect causes one or both feet to rotate inward and down, and though it looks painful, it really is not.
That said, it is important to treat it early so your child can achieve a normal gait and so walking and movement won’t be hindered. Treatment usually starts at about two weeks old, because a newborn’s bones and joints are a lot more flexible and can, essentially, be re-aligned. There are a variety of treatment options, some requiring surgery, others that don’t.
If you’re child is born with clubfoot, it is usually diagnosed almost immediately, and you should talk to your doctor about treatment. Some questions to ask include:
1) Is this a case that will require surgery? If so, what is the aim of that operation?
2) Are there other, non-surgical treatment options that our child might be a candidate for?
3) What kind of follow-up care should we anticipate?
Surgically there are two procedures that doctors generally recommend for clubfoot. One is a tenotomy, which is necessary in the majority of the cases. During this procedure, the Achilles tendon is clipped. It’s considered minor surgery and usually requires only a local anesthetic. The other less common operation is an anterior tibial tendon transfer, in which the tendon attachment is removed from the first toe and attached to the third toe, to release some of the inward tilt and tension on the leg.
A non-surgical approach that has gained popularity in the U.S., and by some estimates has a 95 percent success rate of the child achieving movement comparable to children born with regular feet, is called the Ponseti method. Developed by Dr. Ignacio Ponseti in the 1950s, this method started gaining popularity in the U.S. at the beginning of this century. In this approach, the infant’s foot is manipulated into the correct position, and then placed in a cast or brace that holds it there. The foot is repeatedly stretched, repositioned and re-cast until the foot is finally correctly aligned. Sometimes this treatment continues until the child is about three.
Another non-surgical approach is the stretching and taping method, also called the French method, in which the child’s foot is manipulated and stretched daily, then taped into position. This method requires a lot of commitment, as even once proper alignment is achieved, parents need to continue daily exercises. Some doctors use a combination of this method and the Ponseti method.
Though this is considered a congenital birth defect and its causes are not fully known, smoking during pregnancy seems to significantly increase your child’s risk of being born with clubfoot. Needless to say, if you are pregnant and smoking, you should stop anyway. Also, do not take any drug or medication that you haven’t thoroughly discussed with your doctor. Some doctors have concluded that the connection between Selective Serotonin Reuptake Inhibitors (SSRIs) and the occurrence of clubfoot in infants born to women who took them throughout pregnancy merits further study. If you are currently taking an antidepressant and are pregnant, talk to your doctor.
Though sometimes clubfoot is one of several skeletal birth defects, frequently it is also the only problem in otherwise healthy newborns. Take heart, and know that it’s extremely treatable.