>> [MUSIC] The important thing to know about
a clubfoot is that a clubfoot
isn't just a foot that's in an abnormal position.
It's actually a foot that has been
structurally created differently in the womb.
What that means is that the bones are actually a
little bit different than a foot without clubfoot,
they tend to be a little bit smaller
and shaped a little bit differently.
The muscles and tendons can be a little bit smaller and tighter.
A clubfoot tends to not be as flexible as a non clubfoot.
Oftentimes we can see that the calf is
also smaller as well as the foot being smaller as well.
Even the nerves and the vessels
can sometimes be a little bit differently
formed compared to the other foot or a non clubfoot.
While we know a lot about
the treatment and outcomes about clubfoot,
we actually don't know a lot about what causes it.
It's probably a bunch of
different factors that have led ultimately to a clubfoot,
but there's not one specific cause or
any specific genetics that are involved.
What that means is that there's nothing that you or
your partner did that led to this foot becoming a clubfoot.
[MUSIC] The goal of
a club foot is not to turn this into a not clubfoot.
We accept that this is a clubfoot.
It's always going to want to be a clubfoot,
but what we do know is that if we can take
this foot and get it into a good position where
the foot's on the ground and we
keep it as flexible as possible that
we're able to get patients up and
running and doing all the things that they want to do.
To achieve that goal, we follow the Ponseti method,
which is a series of casts that slowly
stretch out the foot and bring it into that position.
[MUSIC] Often a clubfoot can be diagnosed on prenatal ultrasound.
It might be mentioned to you after one of
your ultrasounds or it's diagnosed pretty soon after birth.
What you'll notice is that the foot has this pointed down,
turned in position,
but it's important to know that this is
not painful at all to your baby.
[MUSIC] We like to
start casting out about one to two weeks of age.
What that means is that there's no rush to
do it while the baby is still in the hospital.
You can go home, rest, relax,
settle into your new life with
baby and then give us a call and we can
oftentimes get you into clinic pretty
quickly to start that casting treatment.
[MUSIC] We are usually able to correct
a clubfoot in about 4-9 casts.
While casting it corrects all aspects of the clubfoot,
but the one thing it can't correct is
the ability to bring the foot up.
To address this, we usually do
a procedure in clinics so it doesn't require
surgery to cut the heel cord or the Achilles tendon.
After we do that,
the foot comes up really nicely
and then we can put our final cast on.
This cast stays on for three weeks and then you come back,
that final cast comes off and then we start bracing.
[MUSIC] Bracing is extremely
important in the treatment of clubfoot.
We know that there's about 100 percent recurrence
in clubfeet that aren't braced.
We normally start with bracing for 23 hours a day.
That means that there are a few breaks
throughout the day where the braces can come off.
You can do a tummy time, give bath,
do some extra snuggle,
and then the braces go back on.
Eventually we do switch to just nighttime or 12-hour bracing,
as the child gets a little bit older,
the transition to bracing can be a little bit tough,
as you can imagine,
this baby almost since the time they were born,
have been wrapped in these fluffy casts for a long time.
The legs haven't been touched or managed and so
the skin can be pretty sensitive to new sensations.
Switching now to bracing,
that's a new sensation for them.
It usually takes a couple of weeks for them
to fully adjust to these new braces,
but it's really important to stay strong during that time.
Babies are pretty smart and they'll learn
quickly that if they cry and the braces come off,
they're going to cry every time the braces go
on and it just becomes even more difficult.
It's important to stay strong early on so that we can be
successful throughout the babies early life.
[MUSIC] The goal of
the clubfoot is to get it into a good position,
keep it as flexible as possible.
We know if we achieve those goals,
that child can run, walk, play,
do whatever sport or activity or any career they want
into adulthood without any difficulty
or thinking about their clubfoot.
[MUSIC] Treatment is not 100 percent successful.
That's even including families that are great with
doing the bracing and being very compliant with that.
We know that there's a certain percentage,
about 20 percent that do require
additional treatments or procedures as the child gets older.
Again, this relates to the fact that this is
a club foot and there are some differences and
how the muscles have been
created leading to some muscle imbalance,
sometimes in the foot.
Sometimes that does require
additional treatment as the child gets older. [MUSIC]