Treatment methods

We move bones and joints into their correct position

Nowadays, conservative treatment, i.e. without surgery, for clubfoot is usually very successful. At Schoen Clinic, we offer your child an effective therapy to correct the malposition completely.

Conservative treatment methods

Pigeon toe treatment

Congenital pigeon toes does not usually require any therapy. Normally, this malposition corrects itself in the course of the first few weeks of life, at the latest within the first year of life. The retrogression usually takes place on its own or with slight support from the parents. Pigeon toe therapy is necessary very rarely.

Clubfoot treatment without surgery: the Ponseti method

Treatment using what is known as the Ponseti method should begin for a mature newborn within the first weeks of life because the tissue is still very elastic. The foot is gently manipulated every week to stretch the short and firm ligaments and tendons on the inside, back and underside of the foot. A plaster cast is then applied from the toes to the groin. It should hold the achieved correction in place and stretch the tissue until the next manipulation. The cast is changed every seven days. In most cases, five to seven casts over a period of five to seven weeks are sufficient to correct the malposition. Even very stiff feet do not need more than eight to nine casts until they are completely corrected. In a final step, which includes a small operation, the Achilles tendon is severed, called an Achilles tenotomy. The skin is anaesthetised using an ointment or injection. Before the incision, a local anaesthetic is injected so that the small incision is not painful for the child. The final cast is then applied. The tendon regenerates with corrected length and strength until the cast is removed after three weeks.

Maintaining the correction: clubfoot splint

Even with very good correction, clubfoot shows a tendency to recur (recurrence). A foot abduction splint is the recommended measure to prevent this. It consists of straight shoes with a high shaft and free toes, which are fixed at the ends of an adjustable splint. The clubfoot splint is worn 23 hours a day for three months and may only be removed for personal hygiene reasons. It is then worn at bedtime until the child’s 5th birthday. It does not cause any delay in motor development in terms of sitting, crawling and running.

The Ponseti method has proved to be a highly effective method of treating clubfoot in newborns for decades. It requires a high degree of cooperation from the parents because it is necessary to wear the foot abduction splint every day. If the clubfoot splint is removed without being replaced, the clubfoot malposition will reoccur.

Follow-up checks in the further course of the treatment

Regular check-ups are necessary once the clubfoot has been completely corrected. The paediatric orthopaedist decides on the duration of the splint treatment. This depends on the development of the clubfoot and its tendency to relapse. Annual check-ups will be necessary until the child is of school age. In order to rule out a late recurrence, a follow-up should be carried out again at the age of about ten years.

If a relapse occurs within the first three years, a cast must be applied once again so that the clubfoot splint can be used again. A second severing of the Achilles tendon is rarely necessary. 

Surgical treatment methods

Surgical treatment: only in exceptional cases

In some cases, conservative therapy is not sufficient and an operation is required. This involves the relocation of a tendon from the inside of the foot to the back of the foot. The leg is then immobilised in a plaster cast until it heals. If the Achilles tendon is shortened again, it must be extended.           
Five to ten per cent of all children suffer from complex clubfoot, which means that the feet can only be influenced by manipulation and plaster treatment to a limited extent. Early surgical severing of the Achilles tendon and a somewhat modified plaster technique are often necessary here, too.