Pediatric Orthopedics
We provide state-of-the-art orthopedic care for the needs of children and adolescents and have the only fellowship-trained pediatric orthopedic surgeon this side of the mountains. We treat sports-related fractures and injuries, bone deformities, hip problems, leg-length differences, fractures, bone infections, scoliosis, clubfoot, and other congenital and developmental conditions.
Pediatric and Congenital Specialties
- Syndactyly
- Thumb Duplication
- Failure of Formation
- Hypoplastic Thumb
- Radial Club Hand
- Constriction Bands
- Obstetrical Palsies
- Vascular Anomalies
CLUBFOOT
Parents know immediately if their newborn has a clubfoot.
Some will even know before the child is born, if an ultrasound was done during
the pregnancy. A clubfoot occurs in approximately one in every 1000 births,
with boys slightly outnumbering girls. One or both feet may be affected.
Without any treatment, your child's clubfoot will result in severe functional disability. With treatment, your child should have a nearly normal foot. He or she can run and play without pain and wear normal shoes. The corrected clubfoot will still not be perfect, however. You should expect it to stay 1 to 1 1/2 sizes smaller and somewhat less mobile than the normal foot. The calf muscles in your child's clubfoot leg will also stay smaller.
Clubfoot Symptoms
The appearance is unmistakable: the foot is turned to the
side and it may even appear that the top of the foot is where the bottom should
be. The involved foot, calf and leg are smaller and shorter than the normal
side. It is not a painful condition. But if it is not treated, clubfoot will
lead to significant discomfort and disability by the teenage years.
Clubfoot Risk Factors
Doctors still aren't certain why it happens, though it can
occur in some families with previous clubfeet. In fact, your baby's chance of
having a clubfoot is twice as likely if you, your spouse or your other children
also have it. Less severe infant foot problems are common and are often
incorrectly called clubfoot.
Non-Surgical Clubfoot Treatments
Stretching and casting. Treatment should begin right away to
have the best chance for a successful outcome without the need for surgery.
Over the past 5 to 10 years, more and more success has been achieved in
correcting clubfeet without the need for surgery. A particular method of
stretching and casting, known as the Ponseti method, has been responsible for
this. With this method, the doctor changes the cast every week for several
weeks, always stretching the foot toward the correct position. The heel cord is
then released followed by one more cast for three weeks. Once the foot has been
corrected, the infant must wear a brace at night for two years to maintain the
correction. This has been extremely effective but requires the parents to
actively participate in the daily care by applying the braces. Without the
parents' participation, the clubfoot will almost certainly recur. That’s
because the muscles around the foot can pull it back into the abnormal
position.
The goal of this, and any treatment program, is to make your
newborn's clubfoot (or feet) functional, painless and stable by the time he or
she is ready to walk. (Note: Anytime your baby wears a cast, watch for changes
in skin color or temperature that may indicate problems with circulation.)
Surgical Clubfoot Treatments
On occasion, stretching, casting and
bracing is not enough to correct your baby's clubfoot. Surgery may be needed to
adjust the tendons, ligaments and joints in the foot/ankle. Usually done at 9
to12 months of age, surgery corrects all of your baby's clubfoot deformities at
the same time. After surgery, a cast holds the clubfoot still while it heals.
It's still possible for the muscles in your child's foot to try to return to
the clubfoot position, and special shoes or braces will likely be used for up
to a year or more after surgery. Surgery will likely result in a stiffer foot
than nonsurgical treatment, particularly as the years pass by.