Bilateral flatfoot before Surgery and  Bilateral flatfoot after Surgery
Ankle Arthroscopy and Subtalar Arthroscopy
Ankle Arthritis in Rhuematoid patient and Ankle Replacement in Rhuematoid Arthritis
Diabetic foot before Surgery and Diabetic foot after Surgery
Claw toe deformity in Rhuematoid patient and Claw toe deformity in Rhuematoid patient after surgery
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Club Foot in India


Dr Bhargava has been treating children with clubfoot since last 18 years. He was responsible for running a special clubfoot clinic where he successfully treated more than 500 children. He also published a research work and thesis entitled “Comparitive analysis of various options in Clubfoot”.

  Introduction  
     
 

Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your child’s foot is twisted out of shape or position.
The term "clubfoot" refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club.

 
   
   
Picture showing Normal foot and Clubfoot
 
   
   

Without treatment, persons afflicted often appear to walk on their ankles, or on the sides of their feet. It is a common birth defect occurring in about one in every 1,000 live births. Approximately 50% of cases of clubfoot are bilateral. This occurs in males more often than in females by a ratio of 2:1. A condition of the same name appears in animals, particularly horses.

Clubfoot can be mild or severe, affecting one or both feet. Clubfoot will hinder your child's development once it's time for your child to walk, so treating clubfoot soon after birth is recommended.

Treatment is usually successful, and the appearance and function of your child's foot can usually be restored to normal.

 
   
   
Symptoms  
   

In most cases, clubfoot twists the top of your child’s foot downward and inward, increasing the arch and turning the heel inward. The foot may be turned so severely that it actually looks as if it's upside-down. Also, the calf muscles in your child's affected leg are usually underdeveloped, and the affected foot may be up to 1 centimeter (about .4 inches) shorter than the other foot. Despite its look, however, clubfoot itself doesn't cause any discomfort or pain.

 
   
       
 
3 months old Clubfoot patient before treatment
 
Same patient after treatment
 
Club foot before treatment
 
Club foot few years after treatment
 
 
   
   

When to see a doctor 

More than likely your doctor will notice clubfoot soon after the birth of your child. Your doctor can then advise you to see orthopaedic surgeon specialising in foot and ankle problems including clubfoot.

Causes
Doctors still aren't certain why it happens, though it can occur in some families with previous clubfeet. In fact, your baby's chance of having a clubfoot is twice as likely if you, your spouse or your other children also have it. In some cases, clubfoot can be associated with other congenital abnormalities of the skeleton, such as spina bifida, a serious birth defect that occurs when the tissue surrounding the developing spinal cord of a fetus doesn't close properly.
Environmental factors play a role in causing clubfoot. Studies have strongly linked clubfoot to cigarette smoking during pregnancy, especially when a family history of clubfoot is already present.

 
   

Risk factors include:

  • Sex.  Clubfoot is more common in males.
  • Family history.  If you, your spouse or your other siblings have had clubfoot, your baby is more likely to have it as well.
  • Smoking during pregnancy.  If a woman with a family history of clubfoot smokes during pregnancy, her baby's risk of having this condition may be 20 times greater than average.

Problems with Clubfoot

Clubfoot typically causes no problems until your child starts to stand and walk. While your child's mobility may be slightly limited and the affected foot may be up to 1 1/2 shoe size smaller than the unaffected foot, treating clubfoot generally ends with your child having a relatively normal foot, both in the way it looks and functions.
Left untreated, however, clubfoot can become a burden. Not only is your child likely to have arthritis, but the unusual appearance of the foot may make body image a concern during the teen years. The twist of the ankle may not allow your child to walk on the soles of the feet. To compensate, he or she may walk on the balls of the feet, the outside of the feet or even the top of the feet in severe cases. These adjustments may inhibit natural growth of the calf muscles, cause large sores or calluses on the feet, and result in an awkward gait.

 
   
   
Neglected Club foot
 
Neglected Club Foot
 
   
   

If your baby is born with clubfoot, he or she will likely be diagnosed soon after birth. Your baby's doctor may refer you to a doctor who specialises in foot & ankle problems and clubfoot treatment.
What you need to tell your child’s clubfoot specialist?
If you have time before meeting with your child's doctor, it's a good idea to make a list of questions. Your time with the doctor may be limited and appointments can go fast, so it helps to be prepared. Here are some questions to consider asking:

 
 
  • What types of corrective treatment are available for my child's condition?
  • Will my child need surgery?
  • What kind of follow-up care will my child need?

In addition, tell your doctor:

  • If you have family members — including extended family — who've had clubfoot
  • If you had any medical issues or problems during your pregnancy
 
     
     
 

Tests and Diagnosis
Most commonly, a doctor recognizes clubfoot after birth just from looking at the shape and positioning of the newborn's feet. The doctor may request X-rays to fully understand the severity of the deformity.
It's possible to clearly see some cases of clubfoot before birth during a baby's ultrasound examination. If clubfoot affects both feet, it's more likely to be apparent in an ultrasound. While nothing can be done before birth to solve the problem, knowing about the defect may give you time to learn more about clubfoot and get in touch with appropriate health experts, such as a genetic counsellor or an orthopaedic surgeon.
Treatment
Because your newborn's bones and joints are extremely flexible, treatment for clubfoot usually begins 7 to 10 days after birth.
The goal of treatment is to restore the look and function of the foot before your child learns to walk, in hopes of preventing long-term disabilities. Treatment options include:
Stretching and casting (Ponseti method)
This treatment entails manipulating the foot into a correct position and then placing it in a cast to maintain that position.
The cast is applied from the toes to just above or below the knee and is changed every week until the deformity is adequately improved. Frequent release of the Achilles tendon is needed to completely correct the deformity. 
After the shape of the foot is realigned, it's maintained through stretching exercises, special shoes or splinting with braces at night for up to three years. For this method to work effectively, you'll need to apply your child's braces according to your doctor's specifications so that the foot doesn't return to its original position.
How often the plasters are changed?
Your child’s foot is manipulated every week and plaster is thereafter changed. The plaster is kept for 3 weeks after Achilles tendon release surgery.
How many plasters are usually required?
Depending upon the severity of condition 5 – 8 plasters are normally required. Sometimes your foot specialist may decide to do a tendon release.

 
   
   
Serial Clubfoot casting
 
Club Foot Ponseti serial casting
 
   
   
   

Surgery
In some cases, when clubfoot is severe or doesn't respond to nonsurgical treatments, your baby may need surgery. Dr Bhargava can lengthen tendons to help ease the foot into a more appropriate position. After surgery, your child will need to wear a brace for a year or so to prevent recurrence of the deformities.

 
   

Follow up after Clubfoot Treatment

 
  1. First follow up after full correction is 6 weeks to three months.
  2. Every four months until age three years (to monitor compliance and check for relapses).
  3. Every six months until age 4 years.
  4. Every one to two years until skeletal maturity.
 

Without any treatment, your child's clubfoot will result in severe functional disability. With treatment, your child should have a nearly normal foot. He or she can run and play without pain and wear normal shoes. The corrected clubfoot will still not be perfect, however. You should expect it to stay 1 to 1 1/2 sizes smaller and somewhat less mobile than the normal foot. The calf muscles in your child's clubfoot leg will also stay smaller.

 
   
   
Case 1  
   
   

Pictures of a child before and after treatment with Ponseti method

 
       
 
Clubfoot case 1 child before treatment
 
Clubfoot case 1 child after treatment
       
 
 
   
   
Case 2  
   
  Clubfoot case 2 child before treatment   Clubfoot case 2 child after treatment
 
Before Treatment
 
3 years after correction