The ideal treatment of bilateral idiopathic clubfoot in a newborn is -
Bilateral idiopathic clubfoot is managed by manipulation & applying cast I.e the surgeon manipulates the foot after sedating the child .The foot is then held in corrected position with plaster casts. There are two philosophies of treatment of clubfoot - * Kite&;s & * ponsetti&;s * kite&;s philosophy- begin at age of 1 month .deformities are corrected sequentially .Adduction deformity is corrected first followed by inversion deformity then equinus deformity . Then a below - knee plaster cast us usually sufficient . the cast is changed every 2 weeks , & continued until it is possible to overcorrect all deformities .once this happens foot is kept in corrected position by maintenance device. *ponsetti philosophy - the calcaneo- cuboid - navicular complex is internally rotated under plantarflexed talus , hence the deformity can be corrected back under talus by gradually stretching the tight structures . This is done by putting thumb pressure under talus .By doing so the calcaneo- cuboid- navicular complex is externally rotated under the talar head .treatment is staed within 1st week of life .cavus aspect of deformity is corrected first ,followed by adduction ,then varus & lastly equinus .after each correction above knee pop is applied , which is changed every 5-7 days .Possible to correct all components within 6weeks.Equinus deformity is often under corrected , can be treated by percutaneous tenotomy of tendoachilles . REF:Essential ohopedics, Maheshwari ,9th edition, pg.no.214
Manipulation by mother
Manipulation and Dennis Brown splint
Manipulation and casts
Surgical release
Pediatric orthopedics