First, congratulations on having a baby!
Second, your baby is going to be okay, I promise.
When my daughter was 20 weeks we found out at a scan that she had a club foot. I was immediately thrown into a tail spin. Did this mean my precious, precious baby might not walk? It was a HUGE shock to my husband and I (you can read more about how we were told the news here), and until we were able to see a specialist, we had to get our information on this condition from Dr Google. We were lucky enough to stumble upon a local New Zealand parents forum where a few parents had shared their experiences, so we were quickly comforted by the knowledge that club foot is treatable. Usually by the time your kid is two, you would never know they had club feet at all.
What is club foot?
Congenital talipes equinovarus (CTEV), also known as Club foot is when the foot turns inward and downward. It is a congenital condition, and can be detected on an ultrasound from about 20 weeks. It is the most common congenital disorder of the legs and can range from mild and flexible to severe and rigid. According to Dr Wikipedia it is a relatively common birth defect, occurring in about one in every 1,000 live births. Approximately half of people with clubfoot have it affect both feet, which is called bilateral club feet. In most cases it is an isolated disorder of the limbs. It occurs in males twice as frequently as in females.
In my daughter’s case there was definitely a genetic component. My mother-in-law stunned us by saying ‘Oh, I had club feet you know’. No, we didn’t know! She is Dutch and had an operation on her feet as a child, and went onto be one of the fittest, most active people I know. Our girl was going to be okay.
How is club foot treated?
Most countries use the Ponseti method to treat club feet as it is less invasive than other methods.
The Ponseti treatment involves weekly casts for 6-8 weeks (from the groin to the toes) and every week its position will be changed to gradually correct the foot position.
In 90% of cases there will be a small surgical procedure at the 6-8 week mark, which involves lengthening the Achilles tendon to enable the foot to be moved into a normal position. Special boots are then worn for 23 hours a day for up to three months, then for up to three years during day time sleeps and bedtime.
Once the Ponsetti treatment is completed the child’s foot/feet will move more freely and they are able to walk and run, their foot/feet is more flexible and normal than with previous treatment methods where a lot of surgical intervention was used.
Sounds okay, but what is it actually like for the parents and their kid?
I’m not gonna lie. It ain’t much fun, especially the cast & surgery part. It multiplies the stress of life with a newborn tenfold (occasionally it feels like a billionfold). It can be hard to know if your kid is crying from hunger or because their cast is making their leg all hot and bothered.
But if you want your child to enjoy normal mobility, tell yourself this – THEY WON’T REMEMBER A DAMN THING – and persevere through the process.
Here are some tips to help you get through each phase of treatment.
- If your child has bilateral club feet, booties (unless specially made by a loving relative) are pretty much out of the question. Use socks to cover those little tootsies – you’re going to have to size up quite a bit to get a sock over that cast.
- If your child has one club foot, make sure you keep the other foot well protected. Newborns have no idea that they have arms and legs and thrash about all over the place, meaning that foot without the cast will keep banging into the foot with the cast. We managed to get some padded booties from Pumpkin Patch (I am in no way affiliated with them), which worked a treat.
- For girls, leggings make nappy changes less of a hassle. For boys I would suggest stretchy pants, and for either gender those bodysuits with a zillion domes that feel like some sort of IQ test to do up are great. Bodysuits with feet are out of the question.
- Casting is messy. Your child will be totally stripped down, and generally Mum is asked to hold and/or nurse the baby, so make sure you are well covered before they begin, because plaster of paris is a b**ch to get out of clothes.
- Your child will hate it. Not only is their foot twisted around, then something cold and clammy gets slapped on the entire leg. I’d scream and wail too. Expect tears. They may cry because later on the cast makes their leg hot or itchy. Unfortunately there’s not much you can do other than give that baby lots of love and cuddles.
- It’s really hard to find pyjamas without feet (this goes for all the later stages too). We didn’t bother with PJ’s during the newborn phase. As your child gets older and becomes aware of the bedtime/PJ ritual, you may have to look hard for appropriate sleepwear. Again, we found Pumpkin Patch to be the best source of footless PJ’s.
Your child will most likely need day surgery to snip the Achilles tendon so that the tendon is lengthened. Our local hospital was brilliant in that they scheduled my daughter’s surgery first for that day. I obviously can’t speak for other hospitals, but I would imagine that most of them do this for babies.
- Because of the anaesthesia, your baby will not be allowed any milk/formula after a certain time (e.g. midnight), and then no water from a certain time. This is the bit that really sucks. There’s no getting around it as you simply cannot have anything in your stomach when you have general anaesthetic due to the risk of choking. This means you will have a screaming, hungry baby. Have someone who does not normally feed the baby (usually Mum) get the baby up and ready, and handle the baby until they go into theatre. My daughter screamed like crazy if I held her because I smelled like milk, so she was held by her Daddy and Oma.
- It will be far more traumatic for you than for your baby. Your kid will not remember this surgery at all. Even though I knew all the information and knew that the surgery was a very minor procedure, I was not prepared for how awful it was to see my baby carried off, having to wait for the all clear, and seeing her absolutely beside herself when she came out of surgery. Because it was a ‘minor procedure’ I’d told my husband to go to work as normal once we’d taken our daughter to the day ward, as his mother had offered to be with me. My MIL was wonderful, but when they took my baby away all I wanted was to sob into my husband’s arms. So take your favourite person in the whole wide world as your support person, you will need them Once she’d had a good feed and a good sleep, my daughter was pretty much back to normal the next day.
- If you’re breastfeeding, you might want to take a bottle or two of expressed milk, just in case. At the time of her surgery my daughter was mixed-fed, and was soooo upset after her surgery she could not latch on to my breast. Fortunately I also had some bottles of formula with me and she was able to take that. It’s perfectly understandable that your hungry, confused baby might take a while to calm down once they are out of surgery.
- Your child’s leg(s) will be put in plaster again for the next three weeks (approx.), and will be assessed by the surgeon before moving onto the next phase.
Your child must wear their boots 23 hours a day for around 3 months. They must. Non-compliance by parents who feel sorry for their child who cries whenever the boots go on is a big problem. It can prolong the treatment, or even mean that your child’s foot goes back into the club position. Persevere. My daughter was generally pretty good about the boots, but whenever I felt tempted to let her have longer spells with them off, I would give myself a good slap. You want your child to walk.
We gave our daughter half an hour with them off after being dressed in the morning, and then another half an hour in the evening once she was in her PJ’s. But whatever works for you will be fine.
- You will be surprised how quickly your child adapts to these clunky boots. Most kids are fine within a couple of days.
- For girls, dresses and tights are the easiest outfit to dress them in for nappy changes. For boys, domed pants or pants with a lot of give in the waist will be the speediest option.
- You may find you need wider sleep sacks if you use them. Try the next size up or have one made.
- Getting your child in and out of a front pack is a pain in the butt. I think I used my pack once during this phase.
- Your child *may* be slightly delayed at moving around (i.e. rolling over, crawling), but most likely not. Our daughter learned to roll during this phase of her treatment. I’ve heard of some babies crawling quite happily too.
- You will have to train any babysitters/carers to put the boots on correctly. I remember being really fastidious with this at first, but it’s amazing how quickly you will all get the hang of it.
The boots-at-night/naps phase:
Again, your compliance with ensuring your child wears their boots for naps and overnight is key. Persevere. As our daughter would sleep for at least 10 hours at night, we were told not to bother with them at nap time. But whatever you get told, do it.
- As your kid may have to wear the boots until they are three, you may have to deal with them kicking up a fuss when the boots go on at night. Our daughter is currently 1 1/2, and only fusses because she knows the boots mean bedtime, rather than her not wanting to wear the boots. For her the boots are a normal part of going to sleep – in fact, we call them her ‘sleep shoes’.
- Your child may work out how to undo them. That hasn’t happened to us yet, but as an insurance policy, we had sleep sacks custom made for our daughter. They are big enough and wide enough to last until our girl is three, and until she works out how to undo the child-proof zipper, there’s no escape for her or the boots.
- Our daughter’s physical development was slightly delayed from the average, but she may have been like that anyway. She didn’t crawl until 9 months, took her first steps at 15 months, and really started walking most of the time at 16 months. Try not to worry if you have a late mover like ours.
At 18 months our daughter walks and runs like most toddlers. You wouldn’t know there was ever anything wrong with her. She has a depression in her left foot that she will always have (not really that noticeable), and her club foot will probably end up a smaller size than her other foot (sometimes the difference can be 2 or 3 sizes). She will probably end up with arthritis in her foot when she is older. But she can walk and run and jump and hop and climb and dance and spin. It’s all worth it.
If your child has club feet and you’d like further advice or support, please leave me a comment with your email so I can get in touch with you.