This explanation focuses on a common foot problem known as Clubfoot or "Kaf Regal Susanit" in Hebrew.
This condition is relatively common among newborns and can vary in severity, ranging from mild cases where the toes slightly point inward and the foot is slightly rounded to severe cases where the foot is severely twisted and deformed. The explanation is provided by the pediatric orthopedic teams and the neonatal department at Shaare Zedek Medical Center to help understand the treatment offered to infants.
Clubfoot deformity is not rare, but it is treatable and allows for normal walking. The newborn will require treatment and monitoring, but the condition improves with time, enabling the child to walk normally once the foot is properly aligned and suitable for regular shoes.
However, it's essential to understand that this deformity is a sign of noticeable impairment. It is not merely an external appearance issue but involves the joints and structure of the foot. It encompasses various deformities along the leg, which cannot be detailed here. Nonetheless, it is crucial to emphasize that without proper and continuous follow-up and professional treatment, severe hindrance to the foot's development may occur. The condition does not stabilize immediately after birth; it progresses and may worsen even during the treatment period.
As far as we know today, deformities begin due to improper nerve and muscle activity, which also affects bone formation and joint structure. Currently, we do not have the means to cure the muscle damage that caused this condition. However, we can influence proper bone and joint growth and maintain good mobility. In the past, a significant part of the treatment relied on foot surgeries. Nowadays, most treatment is performed through manipulation and sequential casting (stretching the foot in a specific direction and applying casts that are replaced every week or two). This approach generally avoids the need for surgery, except for a minor procedure to lengthen the Achilles tendon. The treatment we employ is based on the method developed by Prof. Ignacio Ponseti from the University of Iowa in the USA. It is highly accepted both in Israel and worldwide. You can find more in-depth information about the method, its key aspects, and its global application on various websites, some of which are listed below.
Treatment Goal:
The treatment aims to achieve a proper foot structure so that the infant can start walking without disturbances on time and later use regular shoes.
Treatment Protocol:
1. The treatment begins with foot manipulation and placing immediate postnatal casts.
2. Manipulation and recasting are performed every week or two for 5-8 weeks. We recommend parents remove the casts at home on the day of the clinic visit by soaking them in a solution of water with a little vinegar or gently immersing the feet in warm water with vinegar and gradually opening the cast wraps.
3. An Achilles tendon lengthening procedure (performed in the clinic or the operating room) is necessary for some cases. It is a minor surgery, required for almost all patients. After the procedure, another cast is applied, usually the last in the series.
4. After the final cast removal, parents should obtain a Foot Abduction Brace (Denis-Browne Brace) for the child. For those interested in purchasing a more advanced device online, Ponseti Clubfoot Braces by Mitchell (available on www.mdorthopaedics.com) and Dobbs (available on www.dobbsbrace.com) are highly recommended. Sometimes, adjustments to the treatment order may be needed, mainly in extremely mild or severe cases.
Remember: We cannot guarantee that there won't be any complications during treatment, the treatment may not achieve its full goal, and the child may still require surgery. The treatment is prolonged and requires understanding and commitment from the parents. However, the effort is rewarding. Treating clubfoot in an older child or an adult is much more complicated and may not result in complete recovery.
Additional Information:
Global Help organization's website contains a variety of materials about clubfoot and other medical fields. Enter "Ponseti" or "Ponseti Method" in search engines to find a range of websites on this subject, including parent associations that offer extensive information about the method. In several Israeli portals, such as Tapuz and Walla!, there are active forums for parents of children with health issues, where you can discuss concerns and experiences related to this condition.