HealthInfo Waitaha Canterbury

Club foot

Waewae whakaroto

Club foot, also called congenital talipes equinovarus or CTEV, is a fairly common condition that affects the lower leg. "Congenital" means present at birth, "talipes" means affecting the foot and ankle and "equinovarus" means pointing downwards and inwards.

Around one or two pēpi (babies) in every 1000 are born with club foot, and half of them have both feet affected. It's more common in boys than girls.

Nobody knows what causes club foot, but it could run in the family, or it may be because your baby's muscles did not form properly in the womb.

But club foot is treatable, and your tamaiti (child) will be able to live a normal, active life after they're treated.

Treating club foot

Your baby's club foot may be noticed before they're born during a pregnancy scan. Ideally, you'll have an appointment with the Orthopaedic Outpatient Department (OOPD) before your pēpi is born so you can get the information you need and prepare for the treatment.

Your pēpi should be seen at the OOPD by the time they're two weeks old.

Worldwide, club foot is treated using the Ponseti method. This method has three stages – casting, tenotomy and boots and bar.

Casting

This is the first stage of treatment. Ideally it should start in the first two weeks after your pēpi is born.

Plaster of Paris is used to mould your baby's foot into position and hold it in place. Soft fibreglass then goes over the top of the plaster, extending over the knee and covering the thigh to keep the cast in position. The cast is changed every week for four to six weeks. Casting doesn't hurt your pēpi.

Removing the cast

When the cast is first taken off in hospital, the nurses will show you how to do the first part of the cast removal at home before your future appointments.

• Run a warm bath for your pēpi (either in a baby bath or a large sink).
• Unwind the soft coloured fibreglass outer shell of the cast.
• Remove the cotton wool around the thighs of your pēpi, leaving the white plaster of Paris intact.
• Soak the plaster casts by putting your pēpi in the bath. Massage the casts until they're completely wet and soft.
• Dry and dress the top half of your pēpi in something like a nightie.
• Put small plastic bags over the plaster casts. Put long warm socks over the bags to keep your pēpi warm and dry.
• Nurses in the Orthopaedics Outpatients Department will unwrap the plaster casts.

Tenotomy

This is the second stage. Once your pēpi is out of their cast, they will probably need a small operation to release the tight, short tendon at the back of their heel (the Achilles tendon). This is called a tenotomy.

Your pēpi will have the tenotomy under a general anaesthetic (they will be asleep). It's a very short procedure. Their foot will be put in another cast, which will stay on for three weeks, while the tendon grows and heals.

Boots and bars

This is the final stage of treatment and is very important. Once your baby's foot is in the right position and their Achilles tendon has healed, they need to be in boots and bar to hold their feet in the right position. If they do not wear the boots and bar, their muscles and ligaments will probably tighten and pull their foot back into an abnormal position.

The boots and bar your pēpi wears are made just to fit them. A nurse in the Orthopaedics Outpatients Department will show you how to put them on.

Your pēpi will need to wear the boots and bar for 23 hours a day for the first three months. After this, the time is gradually reduced until your tamaiti child is wearing the brace at night and nap time, at least until they're 2 years old, and maybe for longer. This may seem like a very long time, but most pēpi and parents adapt quickly to the brace, and it becomes part of normal life. It can help to join an online parent support group (find them through the suggested websites at the bottom of the page).

Once your pēpi is in the boots and bar, you'll have fewer follow-up appointments. If you have any concerns about your baby's feet or how the boots and bar are fitting, contact the Orthopaedics Outpatients Department. Phone 027-201-3124 between 8 am and 5 pm. Phone 021-628-224 between 5 pm and 11 pm and on weekends and public holidays.

Tips for using the boots and bar

• When putting them on, lay your pēpi baby on their back or sitting with their feet towards you.
• Your pēpi should always wear socks.
• The buckles go on the inside of the foot.
• It can be difficult to slide your baby's feet into the shoes. Hold their foot on either side of their ankle and put it into the back of the shoe – as far back and down as you can get it. Hold their foot in this position while doing up the buckles. If their foot moves, put it back into the right position.
• Do the middle buckle up first, followed by the top and bottom buckles.
• The middle strap is the most important strap – make sure this is nice and tight.
• Make sure there are no kinks in the leather.
• Do not expect the heel to always come down right from the start – sometimes it can take a few weeks.
• Make sure the length of the bar (from middle screw to middle screw) is the same width or slightly longer than the width of your baby's shoulders. The staff will provide you with a key to adjust the bar.

  Stage	Summary of treatment for club foot
  1	Weekly plaster cast changes for around four to six weeks.
  2	Tenotomy (if needed). A plaster cast is reapplied, then removed at the clinic after three weeks.
  3	Shoes and bar are fitted. For three months your child wears them for 23 hours a day. Afterwards they wear them while asleep until they're at least 2 years old.

Long term and follow-up

Almost all tamariki (children) treated early for club foot lead normal, active lives. They will continue seeing an orthopaedic surgeon until they stop growing, to make sure their foot is staying in the right position.

  HealthInfo recommends the following videos

• Sahva A/S – A parent's guide to clubfoot: the Ponseti method

  This video explains treatment with the Ponseti method and has parents describing how it worked for them and their children.

  HealthInfo recommends the following pages

• Aussie Club Foot Kids

  Information, resources and support for parents of children with club foot.

• Ponseti International

  Information about club foot and the Ponseti treatment method.

• Steps – Understanding talipes/clubfoot

  Information, tips and support for parents.

• Te Whatu Ora – Ponseti boots and bar treatment for clubfoot

  Information about how the Ponseti boots and bar method of treating club foot is done at Christchurch Hospital.

Written by HealthInfo clinical advisers. Last reviewed May 2022.

Sources

Page reference: 132158

Review key: HICLF-132158