Next, the area around the heel is cleansed and numbed, and a small scalpel is used to cut the Achilles tendon. The incision is small so there is minimal bleeding and no need for stitches. The skin is covered with a small dressing, and the foot is placed into a final long leg cast in a fully corrected position. This cast is typically left in place for three weeks. During this time, the Achilles tendon will regrow in a lengthened position. Bracing: After successful correction is achieved through serial casting and Achilles tenotomy, the foot must be kept in a brace to prevent it from returning to the deformed position over the first few years of a childs life. The brace is made up of two shoes or boots that are connected to each other by a bar that is bent under the shoes at 10-15 degrees, or curved to create 10-15 degrees dorsiflexion. This device is also called a foot abduction brace (FAB) or more generally boots and bar (BnB). At first, the brace is worn full-time (23 hours per day) on both feet, regardless of whether the clubfoot affects one or two feet. After 3 months of 23/7 wear, the brace is worn less frequently by gradually reducing hours a couple at a time, every couple months so that hours are down to 12-14 per day at or around a year old.
Prenatal diagnosis by ultrasound can allow parents to learn more about this condition and plan ahead for treatment after their baby is born.More testing and imaging is typically not needed, unless there is concern for other associated conditions. Treatment
Treatment is usually with some combination of the Ponseti method and French method. The Ponseti method involves a combination of casting, Achilles tendon release, and bracing. It is widely used and highly effective under the age of two. The French method involves realignment, taping, and long-term home exercises and night splinting. It is also effective but outcomes vary and rely on heavy involvement of caregivers. Generally, the Ponseti method is preferred. Another technique, the Kite method, does not appear to be as effective. In about 20% of cases, additional surgery is required after initial treatment. Ponseti method
The Ponseti method corrects clubfoot over the course of several stages. Serial casting: First, the foot is manually manipulated into an improved position and held in place with a long leg cast which extends from the toes up to the thigh. After a week this cast is removed, the foot is re-manipulated, and placed into a new cast. This process repeats and the foot is gradually reshaped over the course of 4-6 serial casts, although some feet may require additional casts. The goal of the initial cast is to align the forefoot with the hindfoot. Ponseti describes the forefoot as pronated in relation to the hindfoot, so supinating the forefoot and elevating the first metatarsal improves this alignment.