From the Guidelines
The correct intervention for the infant with clubfoot deformity after delivery is molding cast application to the feet. This condition, also known as talipes equinovarus, is a congenital deformity where the foot is twisted inward and downward. The standard initial treatment involves the Ponseti method, which consists of gentle manipulation of the foot followed by application of a series of casts to gradually correct the position. Treatment typically begins shortly after birth, as the infant's bones, joints, and tendons are most responsive to manipulation during this period. The casting process usually continues for several weeks, with casts being changed weekly to progressively correct the deformity. After the casting phase, most infants require a minor procedure to release the Achilles tendon (tenotomy), followed by wearing a foot abduction brace to maintain the correction. Early intervention with casting is crucial for optimal outcomes and to avoid the need for more extensive surgical procedures later. Surgical correction is typically reserved for severe cases that don't respond to conservative management, not as a first-line treatment. Other options like vitamin D supplementation, glucocorticoid therapy, or observation alone would not adequately address this structural deformity. Given the prenatal diagnosis of clubfoot deformity, it is essential to have a multidisciplinary approach to management, including orthopedic specialists, as suggested by guidelines regarding prenatal evaluation and delivery of patients with skeletal dysplasia 1. Some key points to consider in the management of clubfoot deformity include:
- Early intervention with the Ponseti method
- Regular casting and manipulation of the foot
- Potential need for tenotomy and bracing after casting
- Importance of a multidisciplinary approach to management
- Referral to a specialist center for further diagnostic assessment and management, as recommended for skeletal dysplasia 1.
From the Research
Treatment of Clubfoot
The treatment of clubfoot, also known as congenital talipes equinovarus (CTEV), typically involves the Ponseti method, which consists of manipulation, casting, percutaneous Achilles tenotomy, and bracing 2, 3, 4.
Key Components of the Ponseti Method
- Manipulation of the clubfoot deformity to correct the cavus, adduction, and varus components 2
- Application of a plaster cast with the foot in the corrected position, repeated every 5 to 7 days 2
- Percutaneous Achilles tenotomy to correct the residual ankle equinus 2, 3
- Bracing with a foot abduction orthosis to minimize relapse of the deformity 2, 3, 4
Intervention Required After Delivery
Based on the studies, the infant will require molding cast application to the feet, followed by bracing with a foot abduction orthosis to maintain the correction and prevent relapse 2, 3, 4.
Importance of Adherence to the Ponseti Method
Adherence to the Ponseti method is crucial to achieve successful outcomes and prevent relapse 5, 6. Deviations from the recommended protocol can result in variations in reported success rates and increased risk of relapse 6.
Recommended Course of Action
The recommended course of action for the infant is: