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A Better Treatment for Clubfoot
Clubfoot (Talipes Equino Varus) is the in-turning of the foot and leg during growth in the womb. Although there is a genetic link it is essentially an intra-uterine packing problem resulting from the baby’s position and the amount of room available in the mother’s womb. Untreated, clubfoot results in a crippling, permanent contracture that can only be somewhat improved with surgery often resulting in a lifetime of foot pain. Here at AtlanticProCare, clubfoot can now be treated successfully resulting in a foot that is often indistinguishable from normal.
A new option. Here is a patient of ours who was born with severe clubfeet. He is shown here near the end of treatment, wearing our innovative new braces. At this point the braces would typically only be worn at night.
One year after his treatment was concluded, his feet are now supple, well positioned and fully functional without surgery of any type. There has been no return of the tightness or deformity of the original clubfoot. We see this type of positive result in the majority of our patients.
Traditional treatment for clubfoot Traditional clubfoot treatment involves casting your baby’s leg in progressively better positions over the course of 6 to 8 weeks using the Ponsetti Technique. Following this, the baby is then typically fit with reverse last shoes that are affixed to a bar (called a Denis Browne Bar, originally patented in 1898) that hold the legs apart and in an externally rotated position.
Alternative clubfoot treatments A thermoplastic alternative is the Wheaton Brace. This orthosis is a simple plastic shell intended to hold the foot in an appropriate position after it has been corrected with serial casting. The results for this brace are equivocal and are compounded by the fact that the baby’s leg is held rigidly by strapping the leg and foot to the plastic frame. As you might expect, children often fight against this constraint resulting in discomfort and skin breakdown. It has been most successfully used in treating simple Metatarsus Adductus (in-turning of the forefoot).The French Functional Method is a very humane and successful treatment that was developed in France using extensive stretching of the leg and foot. Although babies respond well to this technique it requires skill, patience and tremendous amounts of time each day making it an impractical solution for most people. Our innovative solution for treating clubfoot Over the past 6 years Jerald Cunningham, CPO, of AtlanticProCare has been developing a practical, effective, alternative to the traditional treatments for clubfoot. Called a Dynamic Torsional KAFO (Knee Ankle Foot Orthosis), this new approach combines the stretching of the French Functional Technique in a lightweight plastic orthosis that allows the child full freedom of motion. That's right, your baby can move their foot and leg in any direction; the can crawl, turn over and even stand with the brace but as soon as they relax for a moment their foot is gently encouraged into the corrected position.
This new brace is dynamic, gently flexing and moving with your baby. Minimal strapping means no skin breakdown and the active, dynamic stretching similar to what a therapist would provide means that the brace is worn for a significantly shorter time than other braces.
Because the brace moves with the natural motion of the foot and leg, normal development proceeds unimpeded and typically your baby is unaware of the orthosis after a short period of initialization.
To see more detailed photos of this orthosis and how easy it is to put on your child, or to check out the Initialization Schedule please check out our DTKAFO Brochure for Parents. The challenge of treating clubfoot Clubfoot (TEV) is a really the combination of several deformities. The foot is plantar flexed (bent downward), the hindfoot is in varus (tipped inward), the forefoot is adducted (rotated torwards the midline), and there is internal tibial torsion (the lower leg is internally rotated). Correcting each of these presents challenges but correcting all of them simultaneously is a unique problem.
Interestingly, the most difficult aspect to treat is providing a meaningful stretch of the heel chord (Achilles Tendon) by flexing the ankle upward. The bones in this area are so small that the available treatments don't exert any meaningful corrective control. Your doctor has to rely on surgery for the child to sever the heel chord, lengthen it and then cast it to allow it to heal in a longer position. This means additional time in casts, scar tissue and sometimes general anesthesia for you child during the procedure.
An in-brace X-ray of a baby's foot in our brace shows that the DTKAFO is actually able to flex the hind foot at the ankle joint. This results in a normal range of motion for the child without the complications of surgery or scar tissue. Note the heel (the oblong bone indicated by the arrow) being flexed upward without over-pressurization of the mid and forefoot.
Working with the leading pediatric orthopedists in Maine We are pleased to be working closely with Dr. Vincent Oliviero and Dr. James Kuhn of Maine Orthopedics, two of Maine's leading pediatric orthopedists. They have been actively involved in the development of this brace and have provided valuable input during its development.
Dr. Vincent Oliviero
Dr. Jamie Kuhn
National Science Foundation Study for new clubfoot treatment During the development of this unique approach to treating clubfoot, AtlanticProCare received a grant from the National Science Foundation to study the brace's efficacy. Please click this link to see a copy of the National Science Foundation Study. NSF reviewers concluded that our Dynamic Torsional KAFO was "...an excellent and novel orthopedic tool to treat infants born with Metatarsus Adductus, Internal Tibial Torsion and Talipes Equinovarus..." and that "the quality of life of the children and the parents will be greatly improved by the proposed product." Since completing this study several years ago, we have worked extensively to further refine this brace and the results have continued to improve. Future plans for the treatment of clubfoot The AtlanticProCare Dynamic Torsional KAFO described here was developed to be used in conjunction with the popular and very successful Ponsetti method of serial casting. The Ponsetti Technique uses a very specific sequence of progressive correction resulting in a functional, well positioned, neutral foot. Our brace and other conventional methods mentioned above are then employed to maintain that correction and increase the flexibility of the leg as the child grows.
Performing this casting weekly over a period of months by a trained orthopedic surgeon makes serial casting a relatively expensive, labor intensive process and requires that the patient has access to sophisticated medical care.
The next step Currently in development at AtlanticProCare is a variation on the Dynamic Torsional KAFO that is intended for use immediately at birth. It is designed to sequentially progress the foot through the same series of corrections as Ponsetti serial casting but using a gentle, persistent, dynamic stretch rather than rigid casting. It is light-weight and potentially inexpensive and can be implemented by trained health care workers rather than orthopedic specialists. How are forces applied sequentially with a single orthosis? Although hard to imagine initially, the secret is that the forces are both dynamic and organized into a strict hierarchy. Initially, for example, the foot experiences an irresistible extension of the first ray as prescribed by Dr. Ponsetti but the other corrective forces are sequentially weaker and are not manifested in the rigid foot until the gentle, persistent stretching is able to overcome the resistance of the foot. At that point the next corrective position is achieved and so on through the entire hierarchy. In a sense the stiffness of the infant's foot determines the progression; each next step is achieved only when the foot is ready to progress to that point. This means that the foot progresses exactly as rapidly as possible for each baby. The result is a duplication of the progression achieved with serial casting through continual, gentle stretching that allows for constant observation of the foot, removal for cleaning and that encourages progression at the rate that the baby can comfortably tolerate. Third world treatment for clubfoot Our area of focus for this new brace would be the underserved populations in third world countries where there is no access to skilled orthopedic care. If successful, this Newborn Dynamic Torsional KAFO would correct the clubfoot deformity that results in permanent crippling, pain and amputation for individuals who would otherwise receive no care. It is being developed on a modular basis that can be mass produced at minimal cost and assembled and fit in the field. Where appropriate, components could even be re-conditioned for re-use. We have worked successfully treating clubfoot with parents from all over the country. If you would like to learn more about your options for treating clubfoot please feel free to call us toll free at 1-877 538 8825 or email us. All initial consultations are free and no-obligation. |
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Check out this video about how to put your baby's brace on.
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This
treatment continues until the age of 3 years old. Although somewhat
effective (between 50%-80% depending on the study), this treatment is
difficult for both the child and the parents; both legs are
constrained whether they both require treatment or not, normal
development like turning over, crawling and standing are
hampered and the bar is cumbersome and awkward in daily use.
Some babies fight the rigid constraints with the result that there
is skin breakdown from the struggling--occasionally the bars
are actually bent by the child. 
.JPG)
These models show the progression of the correction of the foot that is
achieved using the Ponsetti method. A precise order of correction
is necessary to result in the necessary neutral alignment. The
extent of the required change is clear from these images..JPG)
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