Some of you may remember that during a routine ultrasound at 28 weeks, we discovered that our Baby A (Violet) had bilateral clubfeet. At the time, I didn’t know much about clubfeet. We breathed a sigh of relief when we found out that nowadays, correction of this condition has an almost 100% success rate. The correction is not a quick fix though, and I plan to document the process for parents out there who encounter the same issue.
Most doctors in the U.S. use the Ponseti method (also called “serial casting”) to correct clubfeet. This process consists of the doctor gradually manipulating the foot into the proper position using plaster casts. These casts are removed weekly so that the foot can be repositioned, and then a new cast is applied. The cast extends to the upper part of the thigh, so it is a full leg cast.
The earlier you can start this serial casting, the easier it is to correct the feet. Ideally, you want to start treatment during the first two weeks of the baby’s life. Our local orthopaedist wanted to wait until Violet was at a certain weight before she would begin treatment, so we had to wait until she was a little over two weeks old. At the time, Violet showed no signs of the bone condition, so we had no qualms about putting her in heavy plaster casts. This is what her feet looked like when she was a few weeks old, just before beginning the treatment:
And here she is after her first casts were applied:
Here was the amazing progress after one week:
The above picture was taken on October 5th. On October 7th, her femur broke against the weight of the cast when we were trying to change her diaper. Her orthopaedist cut off her cast, and we decided to postpone treatment for a while.
Recently, we decided to switch her care to the OI guru in Omaha. I drove her to the children’s hospital there for her first casts on Wednesday. Here is her “before” picture:
And here she is this morning with her casts on:
As you can see, heavy plaster casts are not holding her down much!
Her doctor said it may take 4-5 weekly casts to obtain the proper correction. After that, she must have a tenotomy during which the Achilles tendon is snipped, and a cast is applied for three weeks. Since her feet did not develop correctly, her Achilles tendon also did not grow correctly. In the three weeks after the procedure, her Achilles tendon will regenerate in its proper position. Once she has the tenotomy casts removed, she will have to wear an orthotic device consisting of tennis shoes with a bar between them, spanning the width of her shoulders. At first, she will wear them full-time, but eventually she will only wear them at night to maintain proper correction. When she is three or four years old, her feet will be considered successfully corrected, and she will no longer have to wear the brace.
Today we noticed that her cast is slipping off because it was applied too loosely. I suspect that the P.A. was afraid of applying much pressure to her legs, so she wrapped the casting material too loosely. Tonight we have to soak the casts off in water and vinegar (during which time Violet has to sit in a tub for three hours because they take forever to soften!), and we’ll return on Monday instead of Wednesday as scheduled to have new casts applied.
This process is no picnic! It’s no surprise that Violet does not like having heavy plaster casts on her legs. She tolerates them remarkably well, but she has her fussy moments. I’m sure the tenotomy is going to be worse for me than for her, and the shoes sometimes cause blisters and result in very fussy babies. I know other babies go through much worse, so I won’t complain too much. And obviously, I am very thankful that such a successful treatment is available!