Club foot
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A club foot, or talipes equinovarusTemplate:Ref (TEV), is a birth defect. The foot is twisted in and down. Without treatment, persons afflicted often appear to walk on their ankles, or on the sides of their feet. It is the most common birth defect, occurring in approximately one to two per 1000 live births. Approximately 50% of cases of clubfeet are bilateral. In most cases it is an isolated abnormality.
Researchers do not know exactly how club foot is caused. Some think it may sometimes be caused by intrauterine compression (possibly from oligohydramnios). Others think it is caused by a genetic malfunction during first trimester development. It can run in families, with incidence rates increasing significantly when multiple direct families members have the condition. Incidence in males is higher than in females.
Clubfoot is treated with manipulation by an orthopaedic surgeon or physiotherapist (common in France - Dr. Bensahel and Dr. DiMeglio are experts in this). In North America, manipulation is followed by casting. The French "physiotherapy method" uses taping to maintain correction. Foot manipulations usually begin within one week of birth. Surgery is usually performed if the foot has not been corrected by ~3 months after birth. Even with successful treatment, the affected foot (if unilateral) may be smaller than the other foot and the calf is frequently noticeably smaller than the normal side.
Another form of correction is known as the Ponseti Method (http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html). Foot manipulations differ subtly from the Kite casting method which prevailed during most of the latter part of the 20th century. Although described by Dr. Ponseti in the 1950's, it did not reach a wider audience until re-popularized by Dr. John Hertzenburg in 2000. The Ponseti method is successful in correcting clubfeet using non- or minimally-surgical techniques, usually within 12 weeks from initiation of treatment. Approximately 80% of infants may require an Achilles tenotomy (microscopic incision in the tendon requiring only local anasthetic and no stitches) performed in clinic between 6 and 9 weeks of age. Maintenance of correction requires the full time use (23 hours a day) of a splint Dennis Brown Bar for three months after achieving correction. Part time use (generally at night, usually 12 hours/day) is frequently prescribed up to 3 years of age. Approximately 20% of infants successfully treated with the Ponseti casting method will require a surgical tendon transfer after two years of age. While this requires a general anesthetic, it is a relatively minor surgery that corrects a persistent muscle imbalance while avoiding disturbance to the joints of the foot.
The long-term outlook (http://www.uihealthcare.com/news/currents/vol1issue1/clubfoot.html) for children who experienced Ponseti Method treatment is comparative to that of non-affected children.