Clubfoot: what it is
The clubfoot it is one of the most common congenital malformations of the bones and joints of newborns (1 in a thousand births) that affects boys more than girls. At birth, in practice, one or both legs appear to be rotated inwards.
Clubfoot: the causes
The causes are not yet well known, but genetic alterations that develop during the 12-16th week of pregnancy are thought to play a major role.
Clubfoot: the diagnosis
If the problem does not emerge with prenatal ultrasound, the diagnosis is made immediately after delivery. And the timeliness of the intervention is fundamental: if not treated or treated adequately, in fact, this disease can cause serious physical disabilities and psychological discomfort.
“In fact, given the high incidence of the disease, represents one of the workhorses of the orthopedist: in fact, a child every three minutes in the world is born with a clubfoot ”explains Gaetano Pagnotta, head of congenital diseases of the skeleton of the Child Jesus in Rome and vice president of Sitop (Italian Society of Orthopedics and Pediatric Traumatology).
“Today the best therapy is considered the Ponseti Method” specifies Carbone, because it is a non-invasive procedure which, as the WHO certifies, has a 98% success rate. “The treatment is all the more effective the earlier it starts, even in the first days of life.” It consists of a series of delicate manipulations by the doctor, followed by the application of a series of plasters, to be replaced approximately every 7-8 days, which progressively manage to correct the deformation.
Usually a minor surgery, which lasts less than ten minutes and requires no stitching (a half-centimeter incision is sufficient), to stretch the Achilles tendon. Immediately after, an additional plaster is applied for three weeks, and then the treatment continues with a brace (two shoes joined by a bar) that the child will have to wear initially day and night and then only at night up to about 4 years.
“The use of the brace is necessary to maintain the correction and avoid recurrence: that is, that the deformity recurs” explains Carbone. “For this reason – Pagnotta reiterates – the treatment does not end as soon as the child gets up, but the use of the night brace must continue until approximately 4 years old”.
“Even the traditional treatment – he adds – consists in the very early application of plaster casts but involves the use of more extensive and invasive surgical interventions, with the risk of adhesions, the formation of internal scars, and with the risk of a foot rigid and contracted. For this reason the Ponseti method is considered the best therapeutic choice “.
Here are some centers, in Italy, specialized in clubfoot treatment with the Ponseti method:
- Rizzoli Orthopedic Institute of Bologna
- Buzzi Children’s Hospital in Milan
- Bambino Gesù Pediatric Hospital in Rome
- Burlo Garofolo Pediatric Hospital of Trieste
- Giovanni XXIII Pediatric Hospital of Bari
- Gaslini Pediatric Hospital of Genoa
- Gaetano Pini Hospital in Milan
- Santa Maria della Stella Hospital in Orvieto
- Tor Vergata University Hospital in Rome