Clubfoot Residual Deformity
Summary
Clubfoot deformity is one of the more common congenital musculoskeletal disorders. The standard treatment for clubfoot is the Ponseti method which involves stretching and then casting the foot beginning after birth. This process is repeated regularly (ex. weekly) until the foot is corrected -usually over a period of months. In most children with a clubfoot deformity a normally functioning foot can be obtained. However, in some patients with a history of a clubfoot deformity a degree of weakness and deformity persists or the deformity recurs. As a result, loading through the foot changes. This can lead to the development of arthritis or stress fractures in the foot and ankle in adults who have a history of clubfoot with a residual deformity. Treatment of residual clubfoot deformities in many cases will be non-surgical with comfort shoes, orthotics, and bracing. For residual deformities associated with painful arthritis surgery to correct the deformity and fuse arthritic joints may be necessary.
Clinical Presentation
Following correction of clubfoot a small percentage of patients will have a residual deformity. The most common residual deformity causes the front of the foot to point and rotate inwards (forefoot adduction and supination). The foot can become stiff and changes the loading through the ankle joint. If left untreated residual deformity can lead to misalignment or degeneration of joints in the foot and ankle (ex. ankle arthritis).
Physical Examination
The physician will assess the patient’s alignment, gait, components of deformity in the foot, range of motion, and skin condition.
Imaging Studies
Weight-bearing X-ray can be used to determine the degree of deformity and the presence of any significant arthritis.
Treatment
The best treatment for clubfoot residual deformity is consistent and thorough treatment of the original clubfoot deformity. This includes consistent use of braces and regular follow-up examinations. Surgery may be a viable option for correcting specific painful residual clubfoot deformities in older children and adult patients. Goals of surgery to treat residual clubfoot deformities typically include: 1) correcting as much of the deformity as possible often by cutting a bone(s) and shifting its position (ostetotomy) and; 2) addressing any painful joint arthritis often by fusing (arthrodesis) the affected joint.
Edited July 3rd, 2020