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How long does it take to correct a clubfoot deformity? One of our twin grandsons was born with this condition. We don't want to see him fall behind his brother in terms of development. What can we do to help?

Clubfoot deformity present at birth is usually treated right away following a protocol developed by an orthopedic surgeon (Ignacio Ponseti, MD). Dr. Ponseti died in 2009 but was Professor Emeritus in the Department of Orthopaedic Surgery at University of Iowa Hospitals and Clinics. The Ponseti Method or Technique is a non-surgical treatment that uses a series of casts, followed by a brace, to correct congenital clubfoot. Each week, the surgeon manipulates the bones of the foot into as close to neutral alignment as possible. The bones are then held in place by a cast. Once a week the cast is removed, the bones are moved again as close to normal as possible and another cast wrapped around the leg to hold everything in place. This weekly treatment continues for about five to six weeks (or until maximum correction possible is achieved). Some surgeons have experimented with doing the procedure twice a week to speed up the process. Five weeks can be whittled down to three weeks if performed every three-to-five days. This modified approach has not been adopted by everyone because there have been some reports of swelling in the feet and toes. But a recent comparison of the standard (once a week) Ponseti method against a modified (twice weekly) approach showed that faster results are possible without problems. The treatment must be followed by a splint worn on the feet to hold the legs in proper position. After surgery, feet are maintained in the corrected position using a special brace or splint called Dennis Browne abduction boots. High-top shoes attached to a bar between the shoes hold the child's feet and ankles apart. The splint is worn 24 hours/day everyday for three months. After three months, the brace is only applied at night while the child is sleeping. Bracing must be continued for two more years. Encouragement and support of the baby's parents in following the surgeons directions is probably the best way to help. Studies show that noncompliance with the home program leads to recurrence of the problem.

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