Prenatal Diagnosis Of Clubfoot And Its Postnatal Treatment

Clubfoot is a common birth defect where the tendons (tissues connecting the muscles to bones) are extensively shorter. As a result, the baby’s foot becomes twisted in shape and position. Reports say most cases of clubfoot are non-syndromic, meaning it doesn’t happen along with other health problems. Still, since the condition can make it harder for a child to walk, it’s crucial to intervene as soon as possible.

Here’s what you need to know about the prenatal diagnosis of clubfoot in babies and things you can expect regarding its treatment and management.

Clubfoot, an Overview

Clubfoot or talipes equinovarus happens when one or both of the feet are significantly plantar flexed. This means the forefoot swings towards the center of the body with the sole facing inward.

It is a common birth defect that can affect the child’s ability to walk. The good news is that it is often an isolated case and the child is otherwise healthy.

Prenatal Diagnosis of Clubfoot

The doctor may suspect clubfoot in a baby through an ultrasound and/or MRI scans. Typically, ultrasound will be performed between the 1st trimester and week 28 of pregnancy. Reports say prenatal ultrasound has an accuracy rate of about 86% with a 14% false positive result.

Clubfoot can be classified into three:

• Idiopathic (congenital) is the most common type where there is a malformation in the blood vessels, muscles, tendons, or bones in one or both feet. Idiopathic cases are isolated and the baby is otherwise healthy.
• Syndromic cases, on the other hand, happen along with other malformations or genetic anomalies.
• Positional clubfoot happens while the baby is still in the womb due to restrictive environments. Fortunately, positional clubfoot is flexible and can be corrected by hand after the baby’s birth. Many cases of positional clubfoot are also self-correcting, meaning they don’t need intervention.

The Treatment and Management of Clubfoot

Should a newborn develop idiopathic or syndromic talipes equinovarus, what can be the mode of treatment?

According to the American Academy of Pediatrics, the Ponseti Method can help. This treatment, which was developed by Ignatio Ponseti, involves three phases:

Phase 1

This involves casting the affected foot within 1 to 3 weeks after birth. The cast is replaced weekly until all elements of the deformity are corrected (except for tight Achilles tendon). In many cases, 7 weeks is enough to complete Phase 1. Please note that only a certified pediatric orthopedic surgeon who knows the Ponseti Method well should do the casting.

Phase 2

It involves a minor surgery, called Achilles tenotomy, to correct the rigid Achilles tendon. This can be done in the doctor’s clinic under local anesthesia. Achilles tenotomy, which makes a small incision in the tendon to allow the affected foot to flex upwards, is often required in 90% of cases. After the surgery, the baby needs to wear a final cast for about 3 weeks.

Phase 3

This involves long-term full-time bracing for 3 months after removing the final cast. After full-time bracing, the baby only needs to wear the brace every night until they turn 4 or 5.

Note that despite the Achilles tenotomy, the American Academy of Orthopedic Surgeons considers the Ponseti Method a nonsurgical way to treat clubfoot in a newborn. Should the deformity persist or come back, they may recommend more extensive surgical procedures.

Key Takeaways

Clubfoot or talipes equinovarus is a common birth defect affecting newborn babies. It can be diagnosed postnatally, but may be detected through routine ultrasound scans. In most cases, the Ponseti method is enough to correct the deformity, although the technique requires the family to religiously follow the treatment plan for years. In more severe cases, the doctor may recommend a more extensive surgical procedure.

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