Background & Etiology
There over 30 joints in the foot that enable us to run, walk, jump, and go about our daily lives. There are numerous structures in the foot that give us precision, control, and a vast range of movement. These structures include bones, tendons, ligaments, muscles and nerves. Sometimes babies can be born with deformities or other problems of the foot that will impact them later in life if not addressed. Club Foot is a common foot condition that affects one in every 1,000 babies.
Immediately when a child is born with Club Foot it can be diagnosed based on the visual appearance of the foot. The foot will be turned to the side and may even look like the top of the foot is where the bottom would be normally. The involved foot, calf and leg will be smaller and shorter than the lower extremity on the other side of the body. There is typically no pain associated with this condition, but it can cause severe discomfort and disability later in life if it goes untreated.
The exact cause of Club Foot is unknown. One or both feet may be affected, and this condition can run in families. The chances of having a baby with Club Foot double if you or your spouse, or your other children have the condition. Club Foot also typically affects more boys than girls.
- Visible deformity of the foot
- A foot that is turned to the side, or even with the top facing downward
- Discomfort if the condition goes untreated as an individual gets older
- Difficulty walking or moving the foot normally, if the condition goes untreated
This condition occurs as a birth defect, so the earlier it is treated the better the outcome. Often treatment occurs when an individual is an infant through non-surgical means. However, if the condition is particularly severe and non-surgical methods are ineffective, surgery may be necessary. The goal of Club Foot treatment is to have the foot in the proper alignment by the time the child is ready to walk.
The treatment of choice is called the Ponseti method, it is a series of stretching and casting that corrects the underlying pathology of the foot. Once the positioning of the foot has been corrected, braces will be required for at least two years to make sure that the correction takes hold. If the braces are not applied, and the regiment of treatment is not upheld, the Club Foot can re-occur because the muscles of the leg will pull the foot back into the improper position.
When non-surgical methods fail to correct a Club Foot, surgery will be used to adjust the positioning of the foot. Surgery for Club Foot is typically performed at the age of nine months to one year. The procedure will correct all of the tissues associated with the Club Foot including the tendons, ligaments, and joints in the foot and ankle that may be affected. Following surgery, a cast and bracing will still be required to ensure that the foot does not go back to the improper position. Surgery can have the side-effect of stiffness as the individual gets older.
Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.
Physical therapy for Club Foot will be used to stretch the structures of the foot including the tendons, ligaments, and muscles to adjust the foot and keep it in the proper position. If surgery is needed, physical therapy will be initiated after the procedure to ensure that the correction takes hold. Bracing will be a critical component of recovery from a fixed Club Foot.
Common Physical Therapy interventions in the treatment of Club Foot include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the foot. The use of mobilization techniques also helps to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the foot and lower extremity to support, stabilize and decrease the stresses place on joint cartilage and the foot joint.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, walking, gait training, running or jumping) of the involved lower extremity to reduce stress on the joint surfaces in daily activities.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold, laser and others to decrease pain and inflammation of the involved joint.
Outcomes and prognosis for individuals with Club Foot will depend greatly on the parent’s ability to keep their child on a strict regiment of treatment coupled with the appropriate casting and bracing. If the treatment program outlined by your child’s pediatric foot specialist is not adhered to, this condition can re-occur.
If the treatment plan is followed children will lead typical lives where they can run, play and even wear normal shoes. However, there may be some lasting effects of Club Foot including a foot that is one to one and a half sizes smaller than the other foot, and calf muscles that remain small on the effected side.