Clubfoot Surgeon in Delhi

1. Understanding Clubfoot

• Appearance: The foot turns inward and downward, often with the bottom of the foot facing sideways or even upward.
• Cause: The exact cause is unknown (idiopathic), but it is likely a combination of genetics and environmental factors. It is not caused by anything the parents did during pregnancy.
• Physical Differences: The affected foot and calf muscle are usually slightly smaller than the unaffected side. This difference typically remains even after successful treatment.
• Is it painful? While the deformity looks severe, it is not painful for infants. However, if left untreated, it leads to significant pain and difficulty walking as the child grows.

2. The Gold Standard: The Ponseti Method

The Ponseti Method is the worldwide standard of care, successfully correcting over 95% of cases without major surgery. It consists of three main phases:

Phase 1: Serial Casting (The Correction)

• Timing: Ideally starts within the first 1–2 weeks of life when tissues are most flexible.
• Process: A paediatric orthopaedic surgeon gently stretches the foot and applies a long-leg plaster cast (from toes to thigh).
• Frequency: Casts are changed weekly for about 5 to 8 weeks. Each new cast moves the foot closer to the correct position.

Phase 2: The Tenotomy (The Minor Procedure)

• Most babies (about 90%) require a "heel cord release" (Achilles tenotomy) once the foot is in the correct position.
• This is a minor, often office-based procedure to lengthen the tight Achilles tendon. A final cast is then worn for about 3 weeks while the tendon heals.

Phase 3: Bracing (The Maintenance)

This is the most critical phase for parents to manage. Because clubfoot has a high tendency to recur (relapse) as the child grows, a brace (boots and bar) is required:

• Full-time: 23 hours a day for the first 3 months.
• Part-time: During naps and at night (12–14 hours) until the child is 4 to 5 years old.
• Note: Failure to follow the bracing schedule is the most common reason for the deformity returning

3. Parent Tips for Care at Home

• Cast Care: Keep the cast clean and dry. Use disposable diapers with elastic legs to prevent leaks into the cast.
• Circulation Checks: Check your baby’s toes frequently. They should be pink and warm. If they turn blue, cold, or disappear into the cast (slipping), contact your doctor immediately.
• Adapting to the Brace: Babies often fuss for the first 24–48 hours in a brace. It is recommended to teach the babies that they can still move by gently pushing and pulling the bar to show them they can kick their legs together.

4. Long-Term Outlook

With proper treatment and adherence to bracing:

• Activity: Children typically walk, run, and play sports just like their peers.
• Footwear: Most children can wear normal, store-bought shoes.
• Results: The goal is a functional, flexible, and pain-free foot. While the affected foot may be one size smaller and the calf thinner, these are cosmetic differences that do not limit the child's ability to be active.

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COMPLEX CLUBFOOT

The term "Complex Clubfoot" (sometimes called atypical clubfoot) refers to a specific variant of clubfoot that does not respond to the standard Ponseti casting technique.

1. What is Complex Clubfoot?

Most complex clubfeet are initially "standard" idiopathic clubfeet that become complex due to casting complications, such as the cast slipping or improper moulding. This causes the foot to become short, stubby, and extremely rigid.

Key Physical Signs (The "Atypical" Look):

• Rigid Equinus: The heel is pulled up very tight and is difficult to bring down.
• Deep Creases: A deep, horizontal crease across the sole of the foot and another deep crease just above the wheel.
• Plantar Flexion: All the metatarsals (bones in the front of the foot) point sharply downward.
• Short, Hyperextended Big Toe: The big toe is shorter than usual and points upward.
• Swelling/Redness: Often, the foot appears puffy or red on the top (dorsum) because of cast slippage.

2. Why it Happens?

• Cast Slippage: If a cast is not moulded well or is too loose, the heel slides up while the forefoot is pushed down, worsening the deformity.
• Premature Stretching: Trying to abduct (turn out) the foot before the "cavus" (high arch) is fully corrected.

3. The Modified Treatment Protocol

The standard Ponseti method must be modified to correct a complex foot.

The "Four-Finger" Technique: Instead of the standard manipulation, the doctor uses both thumbs to push up on all metatarsal heads simultaneously while the index fingers stabilize the ankle.

• Increased Knee Flexion: Casts are applied with the knee bent at 110 degrees (instead of the usual 90) to prevent the cast from slipping off the short, stubby heel.
• Simultaneous Correction: The arch (cavus) and the heel (equinus) are often addressed more aggressively together.
• Limited Abduction: The foot is only rotated out to about 30–40 degrees, rather than the standard 60–70 degrees, to avoid breaking the midfoot

4. Outcomes and Bracing

• Success Rate: Despite being "complex," nearly all these feet can be corrected without major open surgery if the modified protocol is used.
• Cast Count: It typically requires about 5 to 10 casts to achieve correction.
• Bracing Challenges: Because the foot shape is different, the standard "boots and bar" must be fitted very carefully. The shoes are often set to a lower degree of abduction (rotation) initially to ensure the foot stays flat and comfortable.

Summary for Parents

If your child's foot has deep creases in the sole and the heel, or if the casts have been slipping frequently, it may be a "complex" case. In Complex clubfoot, the most important factor is early recognition. Once the medical team switches to the modified "complex" protocol, the success rate is excellent, and the long-term outlook remains a flexible, functional foot.

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POSTURAL CLUBFOOT

It is important for parents to distinguish between "true" (idiopathic) clubfoot and postural clubfoot, as the treatment and outlook are significantly different.

1. What is Postural Clubfoot?

Postural clubfoot (also called positional talipes equinovarus) is a condition where a baby’s foot is turned inward at birth, mimicking the appearance of a true clubfoot, but the foot itself is flexible and structurally normal.

• The Cause: It is generally considered a "packaging" issue. It occurs when the baby is crowded in the uterus during the third trimester, forcing the foot into an abnormal position.
• Key Indicator: Unlike idiopathic clubfoot, which is rigid, a postural clubfoot can be easily and gently moved (passively corrected) into a normal position by a doctor or parent.

2. Diagnosis: Postural vs. Structural

A paediatric orthopaedic surgeon distinguishes the two through a physical exam

• Flexibility: In postural clubfoot, the foot can be moved to touch the front of the shin (dorsiflexion) without resistance.
• Creases: Postural clubfoot typically lacks the deep skin creases on the sole and above the heel that are characteristic of true clubfoot.
• X-rays: Usually not required, as the clinical exam clearly shows the foot's flexibility.

3. Treatment and Management

Because there is no structural bone or tendon abnormality, the treatment is much less intensive than the Ponseti method:

• Observation: Most cases resolve on their own within the first few weeks of life as the baby moves freely outside the womb.
• Stretching Exercises: A doctor or physical therapist may teach parents simple stretching and "tickling" exercises (to stimulate the muscles on the outside of the foot) to perform during diaper changes.
• No Casting or Surgery: In almost all cases, serial casting, tenotomies, and long-term bracing are not necessary.
• Short-term Taping/Splinting: In rare, slightly more "stiff" postural cases, a doctor might suggest temporary taping or a soft splint, but this is the exception, not the rule.

4. Long-Term Outlook

The prognosis for postural clubfoot is excellent:

• The foot will grow to a normal size (unlike idiopathic clubfoot, where the foot is often slightly smaller).
• Calf muscles will develop normally and symmetrically.
• There is no increased risk of the foot turning back in once corrected.
• The child will hit walking milestones on time and will be able to wear any standard footwear.

Important Note: If a "postural" clubfoot does not show significant improvement within the first month of stretching, a follow up is recommended to ensure it wasn't a very mild form of structural clubfoot that might require a few casts.