Diagnostics
The diagnosis is based on the clinical picture of the foot. Another indication can be a very thin and shortened calf. In addition, an X-ray of the foot can be taken to determine the angle between the heel and the calcaneus. This angle is also called talocalcaneal angle and is typically less than 30°. The X-ray image is also needed to plan the therapy optimally and individually and to document the success of the therapy.
Acquired form
In the acquired form of clubfoot, the weakening of the musculus peroneus longus and brevis leads to this malposition. The tibialis posterior muscle gives the foot its typical shape and is therefore also called the “clubfoot muscle”.
Treatment
The treatment depends on the cause and the severity of the malposition but early treatment is very important in all cases. If the treatment is both started early and carried out consistently, the prognosis is good. The foot position should be controlled until the growth is complete. Without treatment, however, the clubfoot remains, which can lead to pain when walking and standing.
Conservative
A clubfoot plaster is available as a conservative therapy. In the congenital form, this therapy is usually started as soon as possible after birth. As a rule, thigh casts are applied, not lower leg casts.
This form of therapy is also called regression treatment. At the beginning, the plaster casts must be changed daily and the foot position must be continuously corrected. Later it is sufficient to renew the casts at weekly intervals.
Physiotherapeutic treatment is recommended to support these treatment measures, as this strengthens and stretches the muscles. Once the malposition of the foot has been corrected, it is still necessary to keep the foot in this position. This is usually done with night splints and additional insoles.
If the malpositioning reoccurs during the course of growth, a final correction can then be made by additionally lengthening the tendon of the “clubfoot muscle”.Another conservative option for the treatment of clubfoot is the correction of the malformation by means of insoles or by fitting a so-called Anti-Varus shoe. There are also other different orthoses available, which are individually fitted by an orthopedic technician. In general, an attempt is made to correct the foot when the knee is bent, with maximum inward bend (raising the outer edge of the foot and lowering the inner one) and lateral abduction.