Talipes

Parent guide to club foot stretches

Step 1: This video was made during the national lockdown as an educational aid for parents managing their babies with congenital talipes equinovarus or ‘clubfoot.’ Mr Flowers demonstrates the initial stretches that are required to correct the foot. Later steps of correction are not shown in this video.

Part 2: When your doctor is happy that your baby’s foot/feet have improved with the first set of stretches, they will show you how to perform the next stretching technique.

This is demonstrated in the video by Mr Cashman, first on baby’s left foot, then on the right. The manipulation is not painful but baby will often shout out at being restrained or held in the stretch position, especially if they are tired or hungry.

What service do we provide?

Our Foot and Ankle Team offers a comprehensive service to children from Sheffield and the surrounding areas, as well as national and international patients.

Treatment is available from birth through to adulthood for Congenital Talipes Equinovarus (CTEV) or Clubfoot as it more commonly known.  This is the most common foot deformity which affects 1 in 1000 births. The condition affects the foot where the heel of the foot is drawn up and the sole of the foot turns inwards. This condition is present at birth and it can affect one or both feet. Most commonly it is ‘idiopathic’ which means there is no known cause.  Occasionally, it can be associated with other congenital malformations or syndromes.

The gold standard treatment across the world is the Ponseti method.  Research has shown that more than 90% of cases with CTEV can be effectively treated with this method.  The goals of treatment are for children to have functional/pain free feet, wear normal shoes and avoid permanent disability.

To ensure the correction is maintained, it is essential for families to fully engage with the treatments. The deformity is very likely to recur if any part of the process is not closely followed by the patient and family.

Specialist care

Our three consultants all have specialist knowledge and expertise in the management of Clubfoot.  They will oversee the management of your child from birth to young adult age, with regular reviews in clinic.  In a small number of cases, your child may require some corrective surgery later in childhood.

Our Advanced Practice Physiotherapist is fully trained in the Ponseti treatment method. They will see your baby at the initial consultation to assess and start the casting process.  They will see you weekly to gently manipulate and cast your baby’s feet.  Our team of casting technicians are all highly experienced in the Ponseti method and they will assist the weekly casting process.

Once the casting phase is complete, your baby will see our specialist orthotists who provide a foot abduction brace (boots and bars). This is an essential part of the Ponseti method. You will be seen for regular reviews and replacement of boots/bar as your child grows. The orthotists are always happy to reply to any queries or concerns you may be having throughout the boots and bar treatment and urgent reviews can often to arranged within 24 hours on weekdays.

Training centre

We are a major centre for training the next generation of paediatric orthopaedic surgeons, having trained many of the top surgeons in the UK and abroad.

Questions about the Ponseti method

How long does it take?

The casting process takes up to six weeks.

How are the casts removed?

Your baby will be bathed and the cast removed by soaking off in water. You will then be able to bath your baby in fresh water. We will also weigh your baby for you if you wish before a new cast is applied.

What is a tenotomy?

Between the fourth and sixth week of casting the doctor will decide if your baby needs a tenotomy. The tenotomy is usually the final stage of the correction and it allows the foot to pull upwards into the position required to fit a shoe.

This is a simple procedure performed in outpatients with local anaesthetic put under the skin a little bit above the heel at the back of the foot. A small skin cut is made to release the Achilles tendon. There is no need for the wound to be stitched. Afterwards a plaster cast will be applied to maintain the position for approximately three weeks until the wound has healed.

You will be asked to give consent for this procedure.

Will my child be in pain after the tenotomy?

Not necessarily the local anaesthetic will help with this. Often the baby cries as they dislike being held still. It is advisable to have some paracetamol at home in case baby is restless when the effect of the local anaesthetic wears off.

What are Boots and Bars?

These are specially fitted shoes that are attached to a metal bar that keep the feet set in a specific position. Both feet have to be placed in the boots and bars but the unaffected foot will be set at a different angle from the affected foot. The orthotic team will fit them and also provide any advice or after care required.

How long are the Boots and Bars worn?

For the first three months (twelve weeks) they must be worn all day and all night except for one hour in the morning or evening when they can be removed for bathing. After this, it will be at night time and at nap times up to a period of four years or as instructed by the doctor or orthotist.

Will I be able to bath my baby?

No, the plaster cast is not waterproof. You will have the opportunity to bath your baby on the return visits when the cast is removed. Until then a daily sponge bath is advised.

What tips do you have for taking care of the plaster cast?

• Keep the cast clean and dry
• Check for cracks or breaks in the cast
• For nappy leaks, wipe the cast as clean as possible with baby wipes only
• Check that you can see all of your baby’s toes
• Check the toes are pink and warm
• Support casts with a rolled up towel (under the knees) if necessary in car seat/sleeping etc.

• Do not put powder or lotions down the cast
• Do not attempt to take off the cast under any circumstances

Are there any signs I should be concerned about?

If you notice any of these or you are worried, then call the hospital for further advice:

• Increased swelling above or below the cast (including toes)
• Fluid or bad smell coming from inside the cast
• Toes are cool or cold
• Toes are not normal skin colour
• You cannot see the toes, they have slipped back into the cast
• The cast is cracked or soft
• Cast is too tight around the top of the leg (can not get your index finger down the top of the cast)
• Your baby kicks the cast off
• Unexplained high temperature