From the Research
The most appropriate next step in management for this newborn is repositioning and serial casting (option D). This infant presents with classic findings of talipes equinovarus, commonly known as clubfoot, which is characterized by the foot pointing downward and inward with a tight Achilles tendon. The persistence of the deformity despite passive manipulation and the confirmatory x-rays support this diagnosis. The Ponseti method, which involves gentle manipulation and serial casting, is the gold standard initial treatment for clubfoot, as supported by the most recent and highest quality study 1. This approach gradually corrects the deformity over several weeks through weekly cast changes, allowing the tight ligaments, tendons, and joints to stretch and remodel. After the casting phase, most infants require a percutaneous Achilles tenotomy (a minor procedure) followed by bracing to maintain the correction, with a success rate of over 90% as reported in the study 2. Some key points to consider in the management of clubfoot include:
- The importance of early intervention, as highlighted in the study 1
- The need for a multidisciplinary approach, including parental education and support, as emphasized in the study 1
- The potential for complications, such as recurrent deformity, if bracing is not done properly or is stopped prematurely, as noted in the study 3
- The safety and efficacy of Achilles tenotomy as an office procedure, as demonstrated in the study 4 Surgery is typically reserved for resistant cases or recurrences, while physical therapy alone, reassurance without intervention, or immediate bracing without prior casting would be insufficient for proper correction of this structural deformity. The Ponseti method has been widely adopted and has shown excellent long-term results, with clubfeet treated with this method functioning as well as normal feet with respect to pain and level of activity, as reported in the study 2.