Casting & Tenotomy

Casting & Tenotomy In The Treatment Of Clubfoot.

“Serial Casting” is the term used to describe the series of casts your baby will need to correct their talipes. The casting phase is the first stage of the Ponseti method, although other methods also use a similar casting method. What makes the Ponseti method unique is the use of full toe to groin casts which prevent your baby’s feet from moving while the cast is on. Toe to knee casts are not as effective as the babies leg can still move at the knee and and the casting won’t achieve the same results.

Your Ponseti Doctor or Physiotherapist is experienced in correctly positioning your babies foot, ensuring all the little bones are in the correct position. If this is not done with care and the bones are not growing in the correct way, your baby may end up with what is called “Atypical Clubfoot”, which may require more invasive treatment to correct. However, even with Atypical Clubfoot all is not lost. Casting may still be successful and surgery is not nearly as major as is has been in years gone by. Just make sure your baby’s feet are seen to by a trained Ponseti Doctor.

Casting should start as soon as possible after your baby is born, but not so soon that you are rushing out of the delivery suit to the Ponseti Doctor. Do take time to recover and bond with your precious new bundle and remember to take plenty of photo’s of his or her little feet too.

Below are 3 images to illustrate before, during and after the casting phase to see how the baby’s foot is corrected.

Your baby may need as few as 5 casts or as many as 7 or 8. This is only dependent on how tight your baby’s feet are and the differing length in time has nothing to do with how “good” or “bad” your baby’s feet are – as with everything, all babies are different!

You might like to get your Doctor or Physiotherapist to save you one of the leg casts so you can look back on it in years to come and marvel at how tiny their feet and legs used to be.

After the casting phase is over many babies will need a small procedure called a “Tenotomy”. This is hopefully the only surgical part of the treatment you will have to face. (A very small percentage of babies with very stiff feet may require more extensive surgery to correct the feet.)

The tenotomy is performed when after the casting phase your baby still has a very tight heel chord (Achilles Tendon). Under either a local or a general anesthetic your Doctor will make a small incision above the heel and will release the tendon. Much of the time this procedure does not even require stitches. Afterwards, your baby will need to wear a cast for 2-3 weeks, during which time the tendon will regenerate at a more appropriate length.

By the time all this is complete and assuming treatment started not long after birth, your baby’s beautiful feet will be corrected and they will still only be a few months old. But now is not the time to be complacent – this is where the real success of the Ponseti method begins. It is time for your baby to start wearing the boots & bars!