Idiopathic Unilateral Clubfoot

Original Editor - Muzaffarabad Physical Rehabilitation Centre Clubfoot Program as part of ICRC and GCI Clubfoot Content Development Project

Top Contributors - Naomi O'Reilly and Rachael Lowe  

Introduction

Around the world, 150,000 - 200,000 babies with clubfoot are born each year [1]. With generally accepted incidences (1 - 3:1000) the estimated load of clubfoot in Azad Jammu and Kashmir (AJK), where 0.11 million births occur every year it would be approximately 250–500 new cases each year. Without treatment, the clubfoot deformity causes a lifetime disability. Use of the minimally invasive Ponseti method is emerging fast in low and middle-income countries, where most of the world's children with clubfoot are born. Untreated children with clubfoot find it difficult to access education, employment and experience exclusion from society.

Patient Characteristics

Abu Bakar is 11 months old and has idiopathic unilateral left clubfoot. He was referred by other clubfoot child’s mother to Muzaffarabad Physical Rehabilitation Centre (MPRC) which is run by Department of Health AJK and International Committee of the Red Cross (ICRC).

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Examination Findings

All the elements of cavus, adductus, varus and equinus were present. He has mild tibial bowing with knee externally rotated.

Clinical Hypothesis

To present treatment response in a child with idiopathic unilateral clubfoot with the Ponseti method.

Intervention

After detailed assessment and proper counselling, Ponseti serial casting was started. Six serial casts were applied to correct, the cavus, adductus and varus deformities and every week the Pirani scoring was recorded.  A percutaneous heel-cord tenotomy was performed to correct the equinus, followed by 3 weeks long cast. This correction was maintained in foot abduction brace (FAB) initially 23 hours a day for 3 months and followed by night splinting which will continue approximately for 3 years. The parents were taught range of motion exercises on removal of the splints. His family provided written consent to present his case.

Outcome

The deformities of Abu Bakar were corrected after seven serial casts. The midfoot and forefoot were corrected to Pirani 0 after six casts. His hindfoot Pirani score was also recorded as 0 after the removal of a three-week casting after his tenotomy. Abu Bakar is on Foot Abduction Brace from last six months and will continue the brace for three more years. From last six months, Abu Bakar has no signs of relapse. The outcome was measured by Pirani scoring.

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References

  1. What is Clubfoot? Global Clubfoot Initiative. http://globalclubfoot.com/clubfoot/ (Accessed online 6 September 2017)