The clubfoot is the most common malformation of the extremities and often occurs during development, so that the child is born with a clubfoot. The handicap can be unilateral or bilateral. A muscle shortening of the Achilles tendon and other genetic factors lead to the formation of a clubfoot, which consists of 4 different foot deformities (see below in the text “Foot deformities”). The foot is thus poorly or not suitable for everyday walking and moving.
Clubfoot in a baby
If the clubfoot is congenital, early therapy is indicated for babies. The treatment continues until the growth phase is complete and is therefore long and costly. A variety of different surgical techniques can be used.
In the first days after birth, the clubfoot should be mobilized into its physiological position and fixed there. This is called redressement and retention. A plaster cast is used for fixation (retention), which can be very tiring to change frequently.
The positioning (redressement) is improved with each new plaster cast. If this conservative therapy is not sufficient, operations can be performed on children (from 3 years of age) to lengthen the Achilles tendon. For parents, the frequent change of plaster cast in the first months of their baby’s life is often a heavy burden. After removal of the plaster cast, intensive physiotherapy treatment begins, during which the remaining joints of the lower extremity are also mobilized.
Physiotherapy
The aim of physiotherapy for clubfoot is to correct the muscular imbalance to the extent necessary to ensure the most physiological joint position possible. This is achieved by intensive stretching of the shortened muscles and the transverse arch, improving coordination and sensitivity. Furthermore, the individual joints can be mobilized manually.
Techniques from the Voita, PNF or everyday movements such as climbing, gait training on certain surfaces, training on the soft floor mat can serve to improve motor skills. The focus is on the correction of muscular imbalances. The Achilles tendon can be stretched, using passive stretching techniques via the movement of the ankle joint, as well as by manual treatment of the soft tissue structures.
Muscles that are not properly innervated can be stimulated by means of electrotherapy. This is especially true for the pronator group, which lifts the edge of the foot outwards. It is of essential importance in the treatment of a clubfoot to minimize effects on other joints, functional limitations and late complications.
For this purpose, the patient’s statics are closely examined, the knee, hip and also the sacroiliac joint as well as the lumbar spine are included in the therapy and the position of the joints in physiotherapy for clubfoot is considered. If one or even several operations have been performed, the scar tissue that has formed should be mobilized in physiotherapy in any case to avoid hardening and immobilization of the tissue. Clubfoot must also be treated outside of therapy in an intensive homework program. It is important to do the exercises regularly until the growth phase is complete.
