Clubfoot, one of the most common problems treated at Shriners Hospitals for Children® – Greenville, is characterized by the foot turned to the side. It may look like the foot is lying on its side with the bottom of the foot facing in towards the middle. The clubfoot may be smaller. It may even need a smaller size shoe then the other foot.
The usual treatment strategy is to correct the position of the clubfoot either by surgery or by a series of casts (Ponseti method), follow the foot as it grows, and do what it takes to keep the foot in the best position possible. Sometimes an operation may be required during the growing years to maintain the position of the foot. The expected outcome is a foot which is near normal in shape, is comfortable in a standard shoe, and functions comfortably with a walking-level intensity of activities.
The foot is not the only problem with clubfoot. With a clubfoot:
- the muscles in the lower leg are smaller
- the calf of the leg may look smaller than normal
- the joints in the ankle are not normal and do not move as much
A baby can be born with one clubfoot or two club feet. If your child is born with 2 club feet, both feet can be treated at the same time.
What Causes Clubfoot?
No one really knows what causes a clubfoot. There are many ideas that might explain what happens.
Some ideas are:
1. The baby’s foot stops growing at a certain point before birth.
2. There is pressure on the baby’s foot in the mother’s womb.
3. One of the bones in the foot doesn’t form right. This causes the rest of the foot to grow crooked.
4. Some of the muscles in the foot do not form right. This causes the bones to grow crooked.
How Often Does Clubfoot Happen?
Clubfoot is one of the most common birth defects. Severe forms of clubfoot affect some 5,000 babies (about 1 in 735) born in the United States each year. Boys are affected with severe forms of clubfoot twice as often as girls. Mild foot deformities are even more common, with both sexes affected in approximately equal numbers.
How is Clubfoot Treated?
The Ponseti method has been around for about 50 years. It was named for Dr. Ignacio Ponseti. This treatment is started very soon after your baby is born. During this time, the ligaments, joints and tendons are the most flexible. The Ponseti method includes gentle massage and moving of parts of the foot to stretch the tight or shortened parts of the clubfoot slowly into a good position. The foot is then held in place with a long leg cast for about a week at a time. During this time, the muscles and ligaments stretch enough to allow a little more correction in the foot’s position. The cast is taken off and the foot is again massaged or stretched and moved into a better position. A cast is put on again. After about 6 weeks (and 6 casts) the foot is in a good position.
To help get the foot in the best position, most babies with Clubfoot will need to have their Achilles tendon lengthened. This is called a Tenotomy. The Achilles tendon is a strong tendon that goes from the calf muscles to the heel. This tendon can be so tight that the foot will not go into the right position. A tenotomy fixes this. This procedure allows the foot to go into the very best position. A cast is put on for the next 3 weeks. The tendon fully heals during this time. This last cast is taken off in the Clinic. To keep the foot from moving back into the wrong position, a special splint (brace) is used.
This special brace is made of 2 high-top, open-toed shoes that are fixed on a metal bar. The brace must be worn full time (23 out of 24 hours a day) for the first 3 months! After this time, your child will be checked in the clinic. If the foot is doing well, your child will be able to wear the brace only at night and during naps. Wearing the brace exactly as you are told is so important! If you do not use the brace the right way each day, the foot may not stay corrected. Children with clubfeet will need to wear the brace until around the age of 4.
Some Famous People with Clubfoot:
- Kristie Yamaguchi: gold medal winning ice skater
- Troy Aikman: played in NFL for Dallas Cowboys
- Damon Wayans: comedian, actor, scriptwriter, director, author
- Mia Hamm: best women’s soccer player in world 1994-1996
Charcot-Marie-Tooth disease (CMT) affects one in 2,500 children in the United States. It is an inherited neurological disorder, which is actually a group of disorders that affect peripheral nerves. Peripheral nerves connect the brain and spinal cord to muscles and organs in the body so that all of the body’s activities are coordinated. These nerves start at the spinal cord and end on a connection with one of the muscles or internal organs of the body. Named for the three doctors who first identified the disease in 1868, it is also referred to as hereditary motor and sensory neuropathy.
CMT is caused by changes or mutations in protein-producing genes that affect the function of the peripheral nerves.
There are different types of CMT that are based upon several types of gene mutations.
Symptoms of Charcot-Marie Tooth Disease
Children diagnosed with CMT disease have varying degrees of symptoms that may include the following:
- Foot drop
- Foot deformities, including high arches and hammer toes
- Loss of muscle in lower legs
- Hand weakness
Diagnosing Charcot-Marie-Tooth Disease
Your child’s doctor will conduct a neurological examination in which they will look for any muscle weakness in the arms, feet, hands and legs, decreased muscle bulk, as well as reduced tendon reflexes and any sensory loss. They may also look for any foot abnormalities and orthopaedic problems such as hip dysplasia or mild scoliosis.
They may recommend that your child undergo the following tests:
Nerve conduction study: This involves placing electrodes on the skin over a peripheral motor or sensory nerve. The electrodes produce an electrical sensation that stimulates these nerves and offers measurable information for your child’s doctor to use to make a diagnosis.
Electromyography: This process requires inserting a needle in the skin to get a measurement of the bioelectrical muscle activity. If there are abnormalities in the readings it may reveal muscle degeneration.
Nerve biopsy: It may be necessary for your child to undergo a nerve biopsy. A very small piece of the peripheral nerve is removed, usually in the calf of the leg, and then examined under a microscope.
Treatments offered for Charcot-Marie-Tooth Disease
While there is no cure for CMT, Shriners Hospitals for Children® does offer treatment plans based on the severity of your child’s symptoms.
Some of the treatments offered include:
Occupational and physical therapy: Your child will work with therapists on a specific program recommended for their individual needs. This may include exercises for muscle strengthening, stamina training and some moderate aerobic exercise. Stretching is also an important part of treatment as it prevents or eliminates joint deformities.
Bracing and Orthopaedic Devices: Your child’s doctor may prescribe bracing for your child’s ankles to provide support and stability in everyday functions such as walking and climbing stairs.
Thumb splints can assist your child with hand weakness and provide the necessary support.
Surgery: In some cases, your child may require surgery to reverse any joint or foot deformities. The specific type of surgery depends upon the severity of their condition and what the doctor feels is the appropriate treatment for your child.