If your baby has club foot, treatment to improve the position and function of their feet will usually begin within a week or two of their birth.
The Ponseti method
A technique called the Ponseti method is the main treatment for club foot, as it has been shown to be more effective and have better long-term results compared to the operations used in the past.
The Ponseti method involves weekly sessions with a specialist, who will manipulate your baby's foot with their hands to gradually alter the bend in it. They will then apply a plaster cast from your baby's toes to their thigh to hold the foot in its new position.
The casts will be changed weekly at each session, and your baby's foot will be altered a little more each time. On average, five or six casts are used, but your baby may need to have a few more or a few less, depending on how severe their club foot is.
The procedure shouldn’t hurt your baby, as it’s a gentle manipulation. Babies often cry, but it isn’t usually due to pain.
Following the manipulation stage, your specialist will decide whether your baby needs a minor operation to release the Achilles tendon (the tight tendon at the back of their heel).
This is often carried out after the front of the foot has been manipulated, but the ankle is still not in the best position (usually after the fourth or fifth cast).
The operation is usually carried out using a local anaesthetic on an outpatient basis, so your baby will not have to stay in hospital overnight. In some cases, a general anaesthetic may be recommended, so that your baby is asleep during the operation.
The surgeon will make a small cut in the Achilles tendon to release the foot into a more natural position. Your baby’s foot and leg will then be put in a plaster cast for about three weeks.
A small number of children will also need further surgery when they are a few years older. This often involves moving a tendon in front of the ankle to a different position, to improve how the foot functions.
Boots and bar
After treatment, your baby will need to wear special boots attached to each other with a bar.
These will hold their feet pointing slightly outwards, at about shoulder distance apart, which will help to prevent club foot returning.
The boots will need to be worn 23 hours a day (they can be removed for up to an hour each day so you can bath your baby) for three months. Then just at night and nap times, until your child is about four or five years old.
Normal shoes can be worn during the day and your child should start to walk and run at the same time as any other child.
It's very important that your child wears the boots for the required amount of time, otherwise their foot may return to how it was previously, and treatment may have to begin again.
Sometimes, club foot can return. This is known as a "relapse" and it’s estimated to happen in one or two out of every 10 cases – most commonly during the boots and bar stage. Relapses are more likely to occur if treatment isn’t followed exactly.
If club foot comes back, it may be necessary for some of the treatment stages to be repeated – for example, the foot may need to be manipulated again and put in a cast. However, in some cases, surgery may be required.
Caring for your child
The charity STEPS helps families of children with club foot. If you want to talk to someone about your child’s condition, you can call their helpline on 01925 750271.
You can also read more about caring for a child through treatment on the STEPS website.