Clubfoot (CTEV) Private Treatment

Introduction 

If your child has possible signs of Clubfoot (foot turning inwards) or has been diagnosed with Clubfoot, seeking the right treatment early is crucial. Mr. Stephen Ng Man Sun our private paediatric orthopaedic surgeon has extensive experience in managing Clubfoot and can help with diagnosis and treatment of this common foot deformity. Early intervention can ensure your child grows up with the best possible foot function and mobility.

What is Clubfoot (CTEV)? 

Clubfoot, or congenital talipes equinovarus (CTEV), is a congenital deformity where a newborn's foot appears twisted out of shape or position. The foot points downward and inward, resembling the shape of a golf club, which is where the condition’s name originates from. This deformity affects the bones, muscles and tendons of the foot and ankle. 

The exact cause of Clubfoot is not entirely understood, but it is believed to result from a combination of genetic and environmental factors. Family history also plays a significant role, as the risk of Clubfoot increases if a parent or sibling has the condition. Clubfoot can also be associated with other medical conditions like spina bifida or arthrogryposis. 

Clubfoot is diagnosed based on the appearance of the foot and confirmed through physical examination by a healthcare professional. In some cases, prenatal ultrasound can detect the condition before birth. 

Key Characteristics of Clubfoot: 

• Cavus: High arch of the foot. 

• Adductus: Forefoot curves inward. 

• Varus: Heel turns inward. 

• Equinus: Foot points downward due to the heel being raised. 

Early diagnosis and intervention are important for successful treatment and to prevent long-term complications.

Are There Treatment Options for Clubfoot in Children? 

Yes, there are several effective treatment options available for children with Clubfoot. Early treatment, ideally starting soon after birth, offers the best outcomes. The primary goal is to correct the foot deformity to ensure normal foot function and appearance. 

Treatment Options: 

• Ponseti Method: This non-surgical technique involves gentle manipulation and casting of the foot to gradually correct the deformity. It is usually followed by a minor surgical procedure called Achilles tendon tenotomy to release the tight tendon. Post-correction, a foot abduction brace is used to maintain the foot's position and prevent recurrence. (Ponseti et al.) 

• French Functional Method: This involves daily physical therapy and stretching exercises, along with taping and splinting to correct the foot's position. This involves daily treatment for several hours over several months and therefore not frequently used.

• Surgical Intervention: In severe cases, relapse (where clubfoot comes back) or when non-surgical methods are unsuccessful, surgery may be necessary. Surgical procedures can include tendon transfers, soft tissue releases, and osteotomies to correct bone deformities. 

Choosing the right treatment plan involves consulting with a private paediatric orthopaedic consultant to tailor the approach to your child's specific needs. Early intervention and adherence to treatment protocols are vital for achieving the best long-term outcomes. 

Why Consider Private Treatment for Clubfoot in Children? 

Choosing private treatment for your child's clubfoot can offer numerous advantages that ensure faster, more convenient care compared to traditional NHS services. 

Time 

• Faster Treatment: By opting for private care, your child can receive treatment often before an NHS appointment becomes available. 

• Convenient Scheduling: Private treatment offers more flexible appointment times to fit around your busy schedule, minimising disruption to your family life. 

Quality 

• Enhanced Facilities: Private hospitals often have better-equipped facilities and luxuries not typically available in NHS settings. 

Comfort 

• Comfort: Private treatment includes facilities like better food choices, private bathrooms, homely rooms, air conditioning, and smart TVs, making the hospital stay more pleasant. 

• Convenient Consultations: You can book consultations directly with our paediatric orthopaedic surgeon, ensuring you have easy access to medical advice and support. 

Attention 

• Personalised Care: With fewer time pressures on staff, private treatment allows for more in-depth consultations, providing more time to talk and receive personalised care tailored to your child's needs. 

More Choice 

• Flexibility: You can choose the location of the hospital, the specific specialist, and the timing of appointments, giving you greater control over your child's treatment journey.

Why Choose Hertfordshire and London Children’s Orthopaedics? 

Mr Ng Man Sun is a tertiary paediatric orthopaedic specialist who treats children with orthopaedic conditions, including clubfoot, with a commitment to excellence and personalised attention. He undertook the prestigious ‘Fred Deitz’ clubfoot fellowship in 2019 and works at Chelsea and Westminster Hospital, a quaternary centre for clubfoot. Here's why you should consider our services: 

• Expertise: Stephen Ng Man Sun is currently the only children's orthopaedic consultant in Hertfordshire who works at a tertiary paediatric orthopaedic referral centre. 

• Extensive Experience: He has vast experience treating childhood conditions, including paediatric fractures and sports injuries, complex foot disorders, clubfoot, childhood hip conditions, neuromuscular problems, and the correction of limb deformity. 

• Positive Feedback: We have numerous positive reviews and testimonials from current and previous patients. Read Testimonials. 

• Multiple Locations: Accessible in two locations to provide you with greater flexibility and convenience. 

• Meet the Specialist: You can find out more about Stephen Ng Man Sun and his approach to paediatric orthopaedic care on our About page. 

Choosing Hertfordshire Children’s Orthopaedics ensures your child receives the best possible care tailored to their unique needs, with the comfort and convenience that private treatment offers. 

When Does Clubfoot Appear? 

Clubfoot is a congenital condition, meaning it is present at birth. It develops during fetal development, and the deformity is often noticeable immediately after birth. In some cases, Clubfoot can be detected through prenatal ultrasound as early as the second trimester. 

What Does Clubfoot Look Like? 

Clubfoot is characterized by a distinct appearance of the foot and ankle. The affected foot is typically smaller than the normal foot and twisted inwards and downwards. The heel points downward, and the front of the foot turns inward. The arch is more pronounced, and the toes may be pointing towards the opposite leg. 

Clubfoot Types: 

Clubfoot can present in several forms, each with unique characteristics: 

• Idiopathic Clubfoot: The most common type, occurring without any associated neuromuscular disorders. It generally affects healthy infants. 

• Neurogenic Clubfoot: Associated with neurological conditions such as spina bifida or cerebral palsy. 

• Syndromic Clubfoot: Occurs as part of a syndrome with other congenital anomalies, such as arthrogryposis or Larsen syndrome. 

• Postural or Positional Clubfoot: Often results from the baby's position in the womb and tends to be more flexible and easier to treat. 

What Are the Symptoms of Clubfoot? 

Clubfoot is usually diagnosed based on its appearance, but there are specific symptoms and signs to look for: 

• Inward Rotation: The foot is turned inward and downward. 

• High Arch: The arch of the foot is higher than usual. 

• Shortened Foot: The affected foot may appear smaller. 

• Calf Muscle Underdevelopment: The muscles in the calf of the affected leg may be smaller and weaker. 

• Stiffness: The foot may be less flexible. 

• Heel Position: The heel is often raised and turned inward. 

What Happens If Clubfoot Is Left Untreated? 

If left untreated, Clubfoot can lead to significant long-term effects. These can include: 

• Impaired Mobility: Difficulty walking or inability to walk correctly due to abnormal foot positioning. 

• Chronic Pain: Persistent pain in the foot, ankle, and leg. 

• Deformity: Permanent deformity of the foot and leg. 

• Secondary Issues: Development of compensatory issues in the hips, knees, or back due to altered gait and posture. 

• Skin and Tissue Problems: Sores, calluses, and infections can develop due to abnormal pressure on the foot. 

Early treatment is essential to avoid these long-term effects of clubfoot. 

Can Clubfoot Be Corrected in Children? 

Yes, Clubfoot can be effectively corrected in children, especially with early intervention. The goal of treatment is to correct the foot's position to ensure normal function and appearance. The Ponseti method is highly successful, especially when started soon after birth. 

How Do You Treat Clubfoot in Children? 

Treatment options for Clubfoot in children are focused on correcting the deformity and maintaining the correction. These include: 

• Ponseti Method: A non-surgical approach involving gentle manipulation and casting of the foot, followed by Achilles tendon tenotomy and bracing. This is the preferred method of treatment in the UK. On average, the deformity can be corrected in 3-4 casts which are applied weekly.

• French Functional Method: Involves daily physical therapy, stretching, and taping. 

• Surgical Intervention: In severe or resistant cases, surgery may be necessary to adjust tendons and bones. 

• Bracing: After initial correction, a foot abduction brace is used to maintain the correction up to the age of 5.

What Is the Success Rate for Treating Clubfoot in Children? 

The long-term prognosis of Clubfoot treatment in children is generally excellent, with most children achieving normal or near-normal foot function. The Ponseti method has a success rate of over 90% when followed correctly. Early intervention and adherence to treatment protocols are crucial for ensuring the best outcomes. Recurrence is possible, so ongoing monitoring and use of a foot abduction brace is essential to maintain the correction.  In the rare occasion where clubfoot relapses (comes back), surgery may be required. Surgical options include: tibialis anterior tendon transfer, release of soft tissue structures or complex osteotomies.

References: 

Ponseti IV, Smoley EN. The classic: congenital Clubfoot: the results of treatment. 1963. Clin Orthop Relat Res. 2009 May;467(5):1133-45. doi: 10.1007/s11999-009-0720-2. Epub 2009 Feb 14. PMID: 19219519; PMCID: PMC2664436. 

Additional Resources: 

NHS Website Resource – Click Here 

Mayo Clinic Resource – Click Here