The newborn feet are two of the most complex structures in the body with a multitude of bones, ligaments, muscles and tendons making up a very flexible unit. Being so complex, there is a huge likelihood of problems being present in the structure and function of the neonatal foot.In fact, foot problems are the commonest structural abnormality seen in newborns. They range in severity from very benign, which require only supervised neglect, to very severe, which require complex reconstructive surgeries for normal walking. Here are a few of the common foot problems seen in the newborn:
Clubfoot is a condition where the foot is turned and twisted inwards, so that the lower plantar surface of the foot is almost facing the leg. The heel cord is tight, making it impossible to correct the foot just by passive manipulation. As the foot and ankle is in a severely twisted position, the foot and ankle cannot move normally while walking. Usually clubfoot is an isolated deformity, though in a small percentage of patients, it is associated with contractures of other joints like hip and knee as well as certain spinal anomalies like spina bifida.
Till a few years back, the only treatment used to be surgical correction of the deformity, which used to make the foot stiff, short and painful. However, in the past decade or two, the “Ponseti” method of serial casting has revolutionized the treatment of congenital clubfoot. This method was described by Professor Ignacio Ponseti from university of Iowa in the mid-60’s but gained popularity in the later part of the twentieth century. In this method of treatment, the deformity is serially corrected using weekly casts followed by a small cut of the heel-cord which can be performed under local anaesthesia. The entire treatment takes around 2-4 months after which a normal-looking, supple and painless foot can be obtained. After good correction is obtained, it is to be maintained using special shoes for a period of 3-5 years. This is perhaps the only method of treatment of clubfoot which has consistently good results even in the long term, especially when treatment has been initiated very early in life.
Clinical photograph of a newborn child with congenital clubfoot (a) showing complete correction of the feet after 3 serial plasters and a small suture-less tendon release.Thus , to summarize, Clubfoot is a relatively common childhood condition that requires vigorous orthopaedic treatment. With expert early treatment, a clubfoot patient will wear regular shoes, take part in sports, and lead a full, active life. Parents who have a child with clubfoot should find an orthopaedic surgeon who is an expert in its treatment and work closely with them to provide the best possible result for their child.
Story of the two brothers: These two siblings had clubfoot. Viraj, the elder one was treated by me for congenital clubfoot with serial casts 3 years back. Now he has absolutely normal-looking feet which are very flexible and is wearing normal shoes. He is one of the most playful boys in his class and regularly comes first in running races. He has brought his brother, Pratik, who also unfortunately has congenital clubfoot, for serial plasters. Pratik also is well on his way towards full correction.
Congenital vertical talus, also known as rockerbottom foot, is one of the serious orthopaedic conditions affecting the newborn foot. This condition is associated with a “break” in the middle of the foot so that the foot looks like the bottom of a rocking chair –hence the name. Congenital vertical talus is associated with other joint abnormalities in almost 50% of cases (unlike clubfoot). Also, unlike clubfoot, the prognosis of this disorder is not all that good, and it requires a prolonged management. Management entails serial plasters for a few weeks to months and then most of them require major surgery even after that.
Clinical picture of a newborn with congenital vertical talus(rockerbottom foot) which looks like the bottom of a rocking chair- hence the name.