Who Treats Clubfoot in Newborns and Infants
Infants with clubfoot should be referred to a pediatric orthopedic surgeon for management. 1
Primary Specialist
Pediatric orthopedic surgeons are the designated specialists for infants with malformations of the limbs, including idiopathic clubfoot and congenital limb deficiencies 1
These surgeons have completed a full orthopedic surgery residency plus an additional ACGME-approved 1-year fellowship specifically in pediatric orthopedics 1
The American Academy of Pediatrics explicitly identifies pediatric orthopedic surgeons as best suited to care for infants (0-1 year) with clubfoot 1
Treatment Approach and Timing
Treatment should begin as early as medically possible, ideally within the first week of life 2
The Ponseti method (serial casting, Achilles tenotomy, and bracing) has become the standard of care and most effective treatment worldwide 3
Initial correction typically requires 4-7 casts applied weekly, with treatment feasible even in premature infants in the NICU 2
Alternative Qualified Providers
Physical therapists trained in the Ponseti method can achieve equivalent outcomes to orthopedic surgeons when performing serial casting for clubfoot 4
A prospective randomized study demonstrated no significant difference in clinical recurrence rates or need for additional surgical intervention between orthopedic surgeons and physical therapists 4
However, pediatric orthopedic surgeons remain the preferred initial referral as they can manage the full spectrum of clubfoot severity, complications, and surgical interventions if needed 1, 3
Critical Considerations
Early referral is essential even if the infant has other medical issues, as treatment can often proceed alongside management of other conditions 2
Relapse rates range from 10-40% and are most commonly due to noncompliance with bracing protocols 5
Parental education about the bracing phase is crucial for treatment success, as premature discontinuation of bracing leads to high recurrence rates 3
More severe clubfoot deformities (such as those associated with distal arthrogryposis) require more casts for correction but can still be successfully managed with the Ponseti method 6
Common Pitfall to Avoid
Do not delay referral to pediatric orthopedics even in sick or premature infants, as treatment can begin safely in the NICU and early intervention optimizes outcomes 2