Treatment of Club foot

Club foot, or "Congenital talipes equino-varus" is the most common significant musculoskeletal congenital abnormality.
It is present in 1 in 1000 births in the UK and between 2 & 3 in 1000 births in Africa.
In Malawi there are 5000 children with untreated clubfeet, and 500 more are born each year!

One of the ways in which we are battling Club Foot in Malawi, as well as Training programmes and spreading awareness is hands on treatment

Cases presenting in the first year of life can be treated by manipulation and casting by the Ponseti method, which can be done by medical assistants, physios, nurses etc.
Children presenting over 1 yr of age however, require complex surgery by orthopaedic specialists…..of which there are only 5 in Malawi...

The Ponseti Method


Ponseti Treatment 1 Ponseti Treatment 2 Ponseti Treatment 3 Ponseti Treatment 4 Ponseti Treatment 5
This method stipulates a specific technique of corrective manipulation followed by plaster immobilisation; thereby avoiding the need for invasive surgery

Sequential Ponseti Casts Cavus, adduction and ankle varus are corrected by weekly manipulation and casting over a period of 5 weeks.

At this stage the only remaining deformity is often equinus for which a percutaneous Achilles tenotomy (“ETA”) is performed followed by a further cast for 3 weeks.


The Colombian Clubfoot Score


Columbian Clubfoot Score - Image 1 Columbian Clubfoot Score - Image 2 Columbian Clubfoot Score - Image 3
This method of assessment introduces objectivity into the treatment of clubfoot with six scored (1, 0.5, 0) criteria:

Hindfoot parameters Midfoot parameters Scores taken at each clinic visit and plotted on a graph, from which response to treatment can be determined


The Steenbeck Foot Abduction Brace (SFAB)


Steenbeck foot Abduction Brace After correction, clubfoot deformity tends to relapse.
To prevent relapses, after the last plaster cast is removed, a foot abduction brace must be worn full-time for 2 to 3 months and thereafter at night for 2 to 4 years.


The benefits of the Steenbeck Foot abduction brace, which can be use to correct the deformity of Clubfoot are: