Who Fits Orthotics for Clubfoot
A pediatric orthopedic surgeon is the appropriate professional to fit and manage orthotics for clubfoot, as they are specifically trained to manage limb malformations including idiopathic clubfoot and oversee the complete treatment protocol including the critical bracing phase. 1
Primary Specialist Responsibility
Infants with clubfoot malformations should be referred to a pediatric orthopedic surgeon who has completed orthopedic residency plus an additional ACGME-approved 1-year fellowship in pediatric orthopedics 1
The pediatric orthopedic surgeon manages the entire treatment continuum, from initial casting through the bracing/orthotic phase that is essential for preventing recurrence 2
Neonates with limb malformations, specifically including idiopathic clubfoot, are best cared for by pediatric orthopedic surgeons as the primary managing specialist 3
The Critical Role of Orthotics in Clubfoot Treatment
The bracing phase is where treatment success or failure is determined, making proper fitting and family education by the specialist paramount:
The Ponseti method (serial casting, Achilles tenotomy, and bracing) has become the most effective treatment for clubfoot worldwide, with the bracing phase being critical to long-term success 2
There is a very high rate of recurrent deformity when bracing is not done properly or stopped prematurely 2
Success requires the Ponseti-trained practitioner (typically a pediatric orthopedic surgeon), primary care clinician, and family working together, with parental understanding of the bracing phase being an important factor in ultimate success 2
Timing and Follow-up
Treatment with the Ponseti method should begin early in infancy, with the orthotic/bracing phase following the casting and tenotomy phases 2, 4
The pediatric orthopedic surgeon maintains oversight throughout the bracing period to ensure compliance and proper fit as the infant grows 2
Long-term follow-up by the pediatric orthopedic surgeon is essential, as recurrent deformity can occur if bracing protocols are not followed 2
Common Pitfall to Avoid
The most critical error is inadequate parental education about the bracing phase. The importance of positive education and support for parents to complete the entire treatment protocol cannot be overstated, as premature discontinuation or improper use of orthotics leads to high recurrence rates 2. The pediatric orthopedic surgeon must ensure families understand that the bracing phase is not optional but essential to maintaining the correction achieved through casting.