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Clubfoot repair

Definition

Clubfoot repair is surgery to correct a birth defect of the foot and ankle.

See also: Clubfoot

Alternative Names

Repair of clubfoot; Foot tendon release; Clubfoot release; Talipes equinovarus - repair; Talectomy; Fusion surgery for the foot; Triple arthrodesis

Description

The type of surgery that is done depends on how serious the deformity is, how old your child is, and what other treatments your child has had.

Your child will have general anesthesia (asleep and not feeling pain) during the surgery.

Your child’s surgeon may make the tendons around your child’s foot longer or shorter. This will help the surgeon put the bones and joints into normal positions. Sometimes, pins are placed in the foot for a time.

  • One or two small cuts are made in the skin around the ankle and foot.
  • A cast is placed on the foot after surgery to keep it in position while it heals.

Older children who still have a foot deformity after surgery may need more surgery. Also, children who have not had surgery for their deformity yet may need surgery as they grow. The kind of surgery they may need are:

  • Osteotomy: removal of part of the bone
  • Fusion or arthrodesis: 2 or more bones are fused together. The surgeon will use bone from somewhere else in the body.
  • Metal pins or plates may be used to hold the bones together for a while.

Why the Procedure Is Performed

Ligaments are tissues that help hold the bones together in your body. Tendons are tissues that help attach your muscles to your bones. A clubfoot occurs when a person has tight tendons and ligaments in their foot and ankle. These tight tissues hold the bones in the wrong position.

A baby born with a clubfoot is first treated with casts.

  • The foot is stretched into a more normal position. Then a lightweight cast is placed on the foot to hold it in position.
  • A new cast will be placed every week so the foot can be stretched further into better position. Cast changes continue for about 2 months.

Clubfoot repair surgery is considered if the cast or other treatments do not fully correct the problem. This will often be done before your child is 1 year old or before they begin standing.

Older children or adults may need surgery if a clubfoot was never treated, or if they still have foot problems after treatment.

Risks

Risks from any anesthesia are:

  • Breathing problems
  • Reactions to medicines

Risks from any surgery are:

  • Bleeding
  • Infection

Possible problems from clubfoot surgery are:

  • Foot swelling
  • Problems with blood flow to the foot
  • Damage to nerves in the foot

Before the Procedure

Your child’s doctor may:

  • Test your child’s blood (do a complete blood count and check electrolytes or clotting factors)
  • Do x-rays of the clubfoot
  • Take a medical history of your child
  • Do a complete physical examination of your child

Always tell your child’s doctor or nurse:

  • What drugs your child is taking
  • Include drugs, herbs, and vitamins you bought without a prescription

During the days before the surgery:

  • About 10 days before the surgery, you may be asked to stop giving your child aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your child’s blood to clot.
  • Ask your child’s doctor which drugs your child should still take on the day of the surgery.

On the day of the surgery:

  • Most times, your child will not be able to drink or eat anything for several hours before the surgery.
  • Give your child a small sip of water with any drugs your doctor told you to give your child.
  • Your child’s doctor or nurse will tell you when to arrive for the surgery.

After the Procedure

Your child will stay in the hospital for about 1 to 3 days right after their surgery. Their hospital stay may be longer if they also had surgery on their bones. Their foot will be kept in a raised position. They may be given medicines to help control their pain.

The skin around your child’s cast will be checked often to make sure it stays pink and healthy. Your child’s toes also will be checked to make sure they are pink and your child can move and feel them. These are signs of proper blood flow.

Your child will have a cast on for about 12 weeks. It will be changed at least 2 or 3 times. Before your child leaves the hospital, you will be taught how to take care of the cast.

When the last cast is taken off, your child’s doctor will refer your child for physical therapy. The therapist will teach you exercises to do with your child to strengthen their foot and make sure it stays flexible.

Your child might need to wear a brace after surgery.

Outlook (Prognosis)

After recovering from surgery, your child’s foot should work like a normal foot. Your child should be able to have a normal, active life. But their foot may be stiffer than normal or stiffer than a foot not treated with surgery.

In most cases, the child’s foot and calf may be smaller than normal the rest of their life.

Children who have had clubfoot surgery may need another surgery later in their life.

References

Canale ST, Beatty JH, eds. Congenital clubfoot (talipes equinovarus) In: Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 26.


Review Date: 12/7/2008
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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