Approach to Clubfeet – Initial Management
Begin treatment of the newborn with above knee casting, even if arthrogrypotic (anticipate that youï¿½ll fix these later on)
– first, try to correct the midfoot/forefoot deformity by reducing the navicular back onto the talus and cuboid back to calcaneus. Do not try to achieve correction of the equinus all in one shot – because the temptation is to push up on the foot to correct the equinus, and you simply break through the midfoot or create a flat-topped talus. Take it in steps. Correct the midfoot/forefoot first, and then gradually get the foot out of equinus.
– the kid returns weekly for cast change
– plan on trying successive manipulations and casting for at least 3 months.
– they then go into an AFO or Denis/Brown boots for a year.
– in the end, if you can get a plantigrade foot with closed reductions and castings, that may be the best result possible.
Complications of closed treatment include
– increased cavus deformity
– rocker-bottom foot
– longitudinal breach
– flattening of the proximal surface of the talus (flat-top talus)
– skin breakdown
– increased stiffness
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