Neglected Clubfoot (CTEV):

Understanding the Condition and Its Treatment

Clubfoot, also known as Congenital Talipes Equinovarus (CTEV), is a birth defect where one or both of a baby’s feet are twisted inward and downward. It is a common condition, occurring in approximately 1 in every 1,000 live births. With early diagnosis and proper treatment, most cases of clubfoot can be corrected, allowing a child to walk and run normally. However, when clubfoot is left untreated or neglected, it can lead to severe mobility problems, pain, and disability in later life. This condition, known as *neglected clubfoot*, requires more complex treatment, but it is still possible to improve function and mobility with appropriate medical care.

What Causes Clubfoot?

Clubfoot is a congenital condition, meaning it develops before birth. The exact cause is not always clear, but it may be due to a combination of genetic and environmental factors. Some families may have a history of clubfoot, and other factors like poor fetal development or restricted movement in the womb might contribute.

How Is Clubfoot Diagnosed?

Clubfoot is typically diagnosed soon after birth, as the condition is visible in the foot's abnormal positioning. In some cases, it can even be detected during an ultrasound scan before the baby is born. The foot appears twisted and stiff, with the toes pointing downward and inward. If left untreated, the child may eventually have difficulty walking, and their foot may appear deformed.

What Happens When Clubfoot Is Neglected?

When clubfoot is not treated in infancy, the condition worsens as the child grows. The foot remains twisted, and the child will likely walk on the outer edge of the foot or the ankle, which can cause significant pain and deformity. Over time, neglected clubfoot can lead to:

- Severe foot deformity: The foot's abnormal shape becomes more pronounced and rigid.

- Difficulty walking: The child may have an abnormal gait, struggle with walking, and experience frequent falls.

- Pain: Walking on the deformed foot can cause pain in the foot, ankle, knee, and hip.

- Social and psychological impact: Children with untreated clubfoot may feel self-conscious about their appearance and may be limited in physical activities, which can impact their confidence and quality of life.

Treatment of Neglected Clubfoot

While early treatment is ideal, it is important to know that even neglected clubfoot can be treated. The treatment approach for neglected clubfoot is more complex than for newborns but can still significantly improve mobility and reduce pain. The main treatments for neglected clubfoot include:

1. Ponseti Method

In some cases, the Ponseti method, which is commonly used for treating clubfoot in infants, can be adapted for older children or adults with neglected clubfoot. This method involves:

- Stretching and casting: The foot is gradually repositioned using a series of casts, which are changed every one to two weeks to slowly correct the deformity.

- Achilles tendon release: A minor surgery may be needed to release the tight Achilles tendon at the back of the ankle, which allows the foot to achieve the correct position.

- Bracing: Once the foot is corrected, a special brace is worn to maintain the new position and prevent recurrence.

2. Surgical Treatment

In cases where the Ponseti method is not effective or the foot deformity is too severe, surgery may be required to correct neglected clubfoot. Surgery aims to:

- Reposition the bones: The surgeon may need to realign the bones of the foot to improve its shape.

- Lengthen or transfer tendons: Tight tendons may need to be lengthened, or some tendons may need to be repositioned to improve the foot’s movement and function.

- Joint fusion: In some severe cases, joint fusion surgery may be performed to stabilize the foot and improve walking.

While surgery can provide significant improvement, it is often more complex in older children or adults compared to infants.

3. Physical Therapy

Following treatment, whether through casting or surgery, physical therapy is essential for strengthening the foot and improving mobility. Physical therapy helps in regaining muscle strength, improving flexibility, and ensuring that the child can walk and run comfortably. Rehabilitation exercises are an important part of the recovery process.

Why Early Treatment Is Crucial

It is always best to treat clubfoot as early as possible, ideally within the first weeks of life. Early treatment is much easier and more effective, often preventing the need for invasive surgery. However, when clubfoot is neglected, it requires a more prolonged and complex treatment process. Parents and caregivers should seek medical advice as soon as possible to prevent further complications.

Preventing Neglected Clubfoot

- Early diagnosis: Make sure to have regular prenatal checkups and follow up with your doctor if any abnormalities are detected in the baby’s development.

- Timely treatment: If your child is born with clubfoot, it’s important to start treatment immediately. The earlier the treatment begins, the better the outcome.

- Education: Parents should be informed about clubfoot, its treatments, and the importance of completing the full treatment plan, including using a brace when necessary to prevent recurrence.

Conclusion

Neglected clubfoot is a serious condition that can lead to lifelong disability if not treated. However, with modern medical techniques and surgery, even neglected cases can be successfully managed, giving children and adults the ability to lead pain-free, active lives. If you suspect your child has clubfoot or has missed early treatment, consult with an orthopedic specialist to explore treatment options.

Dr. Gaurav Jain and the team at OrthoCare are dedicated to providing comprehensive treatment and care for clubfoot, ensuring that every child has the opportunity to grow and develop with healthy, functional feet.