FOOT SURGERY

Clubfoot treatment

The Ponseti method of serial casting is used in the initial treatment of children with this deformity.

Mr Uglow visited The University of Iowa in July 2003 to meet with Dr Ponseti and gain valuable experience in the technique. He won a travel award from The British Society for Children's Orthopaedic Surgery (BSCOS) to assist him.

This is a deformity to the foot which occurs in 1in 1000 live births in this country. Treatment is best carried out soon after birth by a program of serial plaster casts.. This technique has been pioneered by an American surgeon called PONSETI. A cast is applied to the baby after gently stretching the foot and the procedure repeated weekly until the deformity has resolved.

Most children need a tiny operation to cut a tight tendon at the back of the foot (the achilles tendon). This is done under a local anaesthetic. A cast is re-applied for 3 weeks and then the feet are placed in special boots which are connected together by a bar. Theses are worn for about 4 months full time and then at night and at nap time for as long as the child will tolerate them (usually about 3 years).

As the child grows part of the deformity may recur and this may need further casting or surgery. Very severe problems may need to be treated by a complex frame connected to the leg by wires and pins and the deformity is gradually corrected over several months.

Relapses are treated with serial plaster initially and surgery is used for persistent cases. The severest deformities are treated using a special frame called the Ilizarov device.

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