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Pediatric foot deformities – A family affair

The excitement and anticipation of having a new baby can be exhausting and overwhelming, as can the birthing process itself. It is, however, imperative that the new baby be checked over from head-to-toe to ensure that he or she is healthy and off to a great start.

Specific attention must be paid to the lower extremities. Counting out ten toes is simply not enough when checking your newborn’s feet. It is imperative that foot and ankle position is thoroughly evaluated by the nurses and new parents. If there is any question that the foot or ankle appears to be in a strange position or with abnormality this must be brought to the attention of your pediatrician and family podiatrist immediately.

One example of a physical ailment commonly missed at the time of birth is clubfoot. This devastating and crippling deformity is fully treatable in the majority of cases through conservative non-surgical methods. The key to treatment is early diagnosis and swift intervention by the patient’s healthcare team.
Clubfoot deformity, also referred to as Talipes Equinovarus, is a physical foot deformity found in 1 in 1000 live births. It has several theoretical causes, one of which is due to intra-uterine crowding (especially in the first born child) forcing the feet to develop in a twisted position that  makes normal walking activities impossible.

There are several degrees of severity of the deformity which can range from mild to rigid. Early intervention is essential. Consultation with your podiatrist will allow the deformity to be categorized through physical examination and plain film radiographs (x-rays). The information gathered will allow your podiatrist to determine the proper coarse of action which may include a serial casting technique referred to as the Ponseti Method. This method consists of hands-on physical manipulations of the patient’s foot and ankle on a weekly basis to reduce the deformity. Well padded plaster leg casts are applied to maintain the correction achieved by the manipulation. The casts are kept in place until the process is repeated. The deformity is gradually ‘casted out’ over a period of several months, resulting in a virtually normal foot capable of supporting the patient when standing and walking. Following correction, the foot must be maintained with a specialized brace until the patient reaches the age of 4-5 years to avoid recurrence.

Reconstructive surgical intervention is typically required in those patients which go undiagnosed. This is due to the maturation of the patients skeleton which makes physical manipulation very difficult and in most instances renders the Ponseti Method ineffective.

Children grow and thrive with the love and care of their parents, families and friends. It is this foundation that helps to carry them into adulthood and through a lifetime of decision making. The physical foundation of our children is as important as the mental stimuli received from birth. Parents who nurture and nourish their children with love and compassion must also provide them with the very best opportunity to mature physically. This is why parents must be proactive in their child’s health and well being. It is very important to have an excellent rapport and relationship with your child’s physicians and to alert them to anything that you as a parent find concerning about their health.

*Dr. McAleer has lectured internationally on the topic of clubfoot deformity correction.