{"id":2837,"date":"2021-05-02T07:11:55","date_gmt":"2021-05-02T07:11:55","guid":{"rendered":"http:\/\/www.agashehospital.com\/?page_id=2837"},"modified":"2021-05-02T09:17:58","modified_gmt":"2021-05-02T09:17:58","slug":"clubfoot-the-ponseti-management","status":"publish","type":"page","link":"https:\/\/myplus91.ddns.net\/agashehospital\/clubfoot-the-ponseti-management\/","title":{"rendered":"Clubfoot The Ponseti Management"},"content":{"rendered":"\t\t
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Clubfoot the Ponseti Management<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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What is Clubfoot?<\/h2>\n <\/div>\n
\n Clubfoot also called as CTEV (Congenital Talipes Equino Varus) is the commonest inborn deformity of the foot and the ankle occurring in about 1 in 1000 live births.\nIt is characterized by inward and downward turning of the foot and the ankle, with the sole of the foot almost facing the leg. This condition has been known since many centuries with many historical anecdotes about people having clubfoot. <\/div>\n <\/div>\n
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What is the cause of clubfoot?<\/h2>\n <\/div>\n
\n The exact cause of clubfoot remains unclear. In the past, some thought that the baby\u2019s feet were twisted because of the way the baby was positioned in the uterus. This is true only in rare cases that are flexible and easily corrected which is known as \u201cpostural clubfoot\u201d.\nClubfoot is likely caused by a combination of hereditary, genetic and other factors that affect growth before the baby is born. Since the cause is unknown, parents should not worry or feel guilty that something that occurred during pregnancy somehow caused the clubfoot. There is no evidence to support this theory. Although most children with clubfoot are otherwise normal, occasionally they have other orthopaedic conditions such as a hip disorder. Clearly most children with clubfoot are otherwise completely normal and once the foot has been corrected can live a healthy, normal life. <\/div>\n <\/div>\n
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Can Clubfoot be Treated? What is the Treatment for Clubfoot?<\/h2>\n <\/div>\n
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This is the commonest question asked by anxious parents of a child with clubfoot and the answer to the first question is a resounding YES\u2026. Till a few years back, the treatment for congenital clubfoot used to be a big surgery called Posteromedial soft tissue release which used to give a big ungainly scar and render the foot stiff, painful and scarred. Since the past couple of decades, the treatment initiated by Professor Ponseti from the university of Iowa in the United States has gained worldwide acceptance and has revolutionized the treatment of congenital clubfoot.\"\"<\/p>

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Ponseti treatment of congenital clubfoot involves serial manipulation and plaster application of the child\u2019s foot every week, in order to correct all the components of the deformity. This serial plastering should be started as early as possible after birth, sometimes even starting from the first day or within the first few days of life. Usually about 3-8 plasters are needed. In most of the cases (about 90-95%), the heel cord, also called the tendoachilles is tight, which cannot be corrected by plastering. In these cases, a small surgery in the form of the tendoachilles tenotomy needs to be performed which is a very small surgery performed at the Agashe Paediatric Su
\nperSpeciality Care by Dr. Mandar Agashe by a fine needle, which gives a scar almost as small as a needle prick. The advantages of the Ponseti method are that the treatment gets over very early, by around 3 months and the foot remains unscarred, supple, flexible and absolutely painfree. Thus this methods converts the need for a big scarring surgery into a small non-scarring one.<\/p>\n

Special shoes known as \u201cSteenbeck\u2019s shoes\u201d are provided to every patient which are to be worn every day for around 23 hours a day (ie almost continuously)for around 3-4 months till about 6-7 months of age after which the child \u201cgraduates\u201d to only night time and nap time brace wear till about 3 years of age. It cannot be stressed enough that bracing is a very important component of the treatment and under no circumstances, should be discontinued without the explicit instructions of the treating doctor.
\nYour doctor Dr. Mandar Agashe has extensive experience with treatment of clubfoot, with training initially at the BJ Wadia hospital, which is one the biggest referral centres for clubfoot in western India as well as Rady Children\u2019s hospital at San Diego. He has presented his work at the International clubfoot congress at Prague, Czech republic and was one of the few orthopaedic surgeons from India to have been invited to attend the 2nd Ponseti International Meeting at Iowa City, to present his work at that august gathering.<\/p>\n<\/div> <\/div>\n <\/div>\n \n <\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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How should we take care of the cast?<\/h2>\n <\/div>\n
\n The first 24 hours after the cast is applied, your baby may be restless but he\/she should be comfortable after that time. Please perform the following:\n\n1. Check the circulation in the foot every hour for the first 12 hours after application, and then four times a day. This is done by pinching the toes and watching the return flow of blood. The toes will turn white and then return quickly to pink if the blood flow is good to the foot. This is called blanching.\nIf the toes are dark and cold or do not rapidly return to pink when released, the cast may be too tight. If this occurs, call us immediately and inform the hospital about this condition. In all likelihood, we would ask you to remove the plaster ASAP and then report to our hospital.\n2. The top of the toes should be exposed. If you cannot see the toes, it may mean the cast has slipped and correct reduction is not being maintained. If this happens call the hospital ASAP.\n3. Keep the cast clean and dry. The cast may be wiped with a slightly dampened cloth if it becomes soiled. Keep the top of the cast outside the baby\u2019s diaper to prevent soiling.\n4. The new cast should be placed on a pillow or soft pad because hard surfaces may dent wet plaster. Whenever your child is on his\/her back, place a pillow under the cast to elevate the leg so the heel is just beyond their pillow. This prevents pressure on the heel.\n5. Use disposable diapers and change the baby often to prevent cast soiling. Apply the diaper above the top of the cast to prevent urine\/stool from getting inside the cast. Diapers with elasticized legs work well.\n\nNotify us if you notice the following:\n-Any drainage on the cast.\n-Any foul smelling odors coming from the inside of the cast.\n-If the skin at the edges of the cast becomes very red, sore or irritated.\n-If your child runs a fever of 38.5\u02daC\/101.3\u02daF or higher without an explainable reason, such as a cold or virus.\nRemoval of the cast before every plaster:\nThough Agashe Paediatric SuperSpeciality Care has very advanced instruments for cutting the plaster, we prefer that the parents of the child remove the plaster on their own a few hours before reporting for the next plaster at home. This can be done by dipping the plaster in lukewarm water for a few minutes till it becomes soft and then actually unrolling the plaster rolls in the reverse direction of application. We always keep small knobs at the end of each plaster roll, so that the parents know exactly where to unroll it from. This is a much more child-friendly practice than the cast saw as it has been noticed that the noisy cast saw can cause severe stress to the child and has a great danger of cast saw burns on the delicate skin of the child. <\/div>\n <\/div>\n
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Can this deformity recur?<\/h2>\n <\/div>\n
\n Unfortunately Yes, it has a 15% chance of recurrence worldwide, and as has been mentioned before, the commonest cause for recurrence is Non-compliance with brace wear.
\nThat is the reason we insist on prolonged Steenbeck splint wear for a period of three years. Once recurrence occurs, treatment differs depending on the extent and severity of deformity ranging from simple re-plastering to surgery in the form of transfer of the offending tendon to a more corrected position. <\/div>\n <\/div>\n
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Is my child going to walk normally?<\/h2>\n <\/div>\n
\n Again, the answer is a resounding YES\u2026.. kids with congenital clubfoot who have been treated by the Ponseti method are going to walk, run and do all normal day to day activities without any restriction with no or very minimal limp or abnormal gait. <\/div>\n <\/div>\n \n <\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\tNote: All content presented on this website is intended for informational purpose only. The information on this website should not be used as a basis for diagnosis or treatment without an examination by a medical practitioner.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Clubfoot the Ponseti Management What is Clubfoot? Clubfoot also called as CTEV (Congenital Talipes Equino Varus) is the commonest inborn deformity of the foot and the ankle occurring in about 1 in 1000 live births. It is characterized by inward and downward turning of the foot and the ankle, with the sole of the foot […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"ocean_front_end_style_editor":"no","ocean_post_layout":"full-width","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"0","ocean_second_sidebar":"0","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"0","ocean_custom_header_template":"0","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"0","ocean_menu_typo_font_family":"0","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"on","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"0","footnotes":""},"class_list":["post-2837","page","type-page","status-publish","hentry","entry"],"yoast_head":"\nClubfoot The Ponseti Management - Agashe Hospital<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/localhost\/agashehospital\/clubfoot-the-ponseti-management\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Clubfoot The Ponseti Management - Agashe Hospital\" \/>\n<meta property=\"og:description\" content=\"Clubfoot the Ponseti Management What is Clubfoot? Clubfoot also called as CTEV (Congenital Talipes Equino Varus) is the commonest inborn deformity of the foot and the ankle occurring in about 1 in 1000 live births. 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