| Atypical or Complex Clubfeet |
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- The term Atypical Clubfeet, also known as
Complex Clubfeet, refers to clubbed feet that
are short and blocky in appearance and have
marked creases in the sole of the foot.
No conversation about clubfeet can be complete until the subject of Atypical or
Complex clubfeet has been discussed. To the parent who has never
experienced clubfoot before, never witnessed it, and has no prior information
about it, the issue of atypical feet can easily go past them un-noticed.
If you did not know something could be one of two ways, you would not know
you had the worse of the two situations. You wouldn't know that your baby had
atypical or complex feet, nor that such feet require special care.
- Worst of all you wouldn't know that while there
are still very few doctors who can perform the
non-surgical Ponseti Method of correction with
success, there are even fewer still who can
correct an atypical foot successfully.
In un-trained hands, these are the feet that end up wearing serial casts for
months on end, showing very little progress, and eventually are subjected to
serial surgery as a last ditch effort. Again, if you are the parent with no prior
experience, how would you know the difference?
Nine years ago I didn't know the difference either. I didn't know anything about
clubfoot, or that there was such a thing as atypical clubfeet, often referred to as
"complex" clubfoot. I didn't know there were very plain warning signs that
could have been easily noticed even by someone who was as ignorant as I
was back then.
It appears that the atypical condition can be both "born" to the baby, and
"created" after the birth by inferior serial casting methods. Too often, babies
who have atypical clubfeet, through either source, are classified as being those
who do not and can not respond to the Ponseti serial casting methods.
- After you have watched your baby endure weeks
or even months of casts with little to no progress, it
sounds perfectly logically when your doctor finally
says, "She isn't responding to treatment.
Unfortunately there are those few children who
don't, so we're only left with one option...
(surgery)." It is hard news to hear, but it sounds
so logical in light of all you've been though that you
don't hesitate to agree with the doctor.
Young children, such as the baby pictured at the top of this page, still have a
remarkable chance of achieving that 100% correction goal despite their feet
being atypical, IF, (big if!) the doctor who is treating the feet has a lot of
experience in treating them. Remember: very few doctors do have that
experience. Obviously the doctor in this case did not have that experience or
the feet would have been well corrected by now.
Older children, as was the case with my oldest son, may not respond as
successfully to non-surgical correction, and may need to have the ATTT
surgery to complete their treatment. Obviously, the key here is to diagnose
the feet as Atypical as early as possible, and then seek out a physician who is
capable of handling this condition correctly.
Locating the right doctor in this case is likely to involve travel and hardship on
the family. Not locating the right doctor is going to induce hardship on the
baby for the rest of his or her life. It's a small trade off for a huge pay off
in the end.
There are things you as the parent can look for that will alert you that your child
has the atypical condition. Do not worry now if the child was born with it, or if
the doctor created it - only understand that if your child is atypical, he or she is
going to need very specialized treatment to enjoy a life on normal, non-
surgically-altered feet.
- The most obvious clue is how the feet look. Take a
moment to study the photos of atypical clubfeet on this
page. We often lovingly refer to them as "Fred Flintstone"
feet, or little Sausage Feet. They are blocky, fat, square
and will have deep creases on the sole.
- If the child has worn casts for more than nine weeks, pay
attention.
- If your baby's feet look anything like these, then pay
attention.
- If the casts applied often slip or fall off completely, pay
attention.
- If your doctor says your baby is not responding to the
serial casting treatment, pay attention.
- If he starts talking about the surgery(s) the baby will need
in the future, definately pay attention.
- If your baby cries with obvious pain during and after the
casting.
- If you have to physically restrain the infant during casting.
- Other warning signs to look out for are "Half Casts" which
only come up to the knee, and doctors who let you take
the cast(s) off at home the day before another one is
applied - or worse, doctors that let your ride out a
weekend or a holiday with no casts on at all.
Atypical clubfeet can be corrected with success, and with out surgery if they are
caught early enough in infancy and then treated correctly from there. Any
baby born with clubfoot should only take an average of five weeks to correct.
The range is from three to nine weeks, so if your baby has been wearing casts
for more than nine weeks and the feet aren't getting seriously better, it's time
to seriously reconsider your treatment plan. Prolonging the casting at this
point is only prolonging the suffering of a child that is being mistreated. You
are also decreasing the chances that your child will grow up on normal feet.
The child in the photos at the top of this page went through nine weeks of serial
casting. At that point his doctor said his feet "Don't look too bad." and told
the parents to put the child in to his foot abduction brace. The brace would
not stay on, obviously, and the child was in misery trying to wear it, naturally. It
was at this point that his parents began to suspect something was wrong. They
were right in their assumptions! The good news is that this baby will soon be
treated by Dr. Ponseti. We are going to follow that treatment process, posting
the photos as we go so you too can witness the truth about atypical clubfeet.
Inferior casting methods along with a misunderstanding of how the clubfoot
works both before and during treatment often leads doctors to treat the foot
incorrectly, which could result in the atypical or complex condition that is then
further more difficult to treat even by a highly skilled Ponseti authority. Difficult
yes, but impossible? No. Even if improper casting does not cause the foot to
become atypical, improper casting will bring it's own host of problems,
prolonging correction if not failing to correct it completely.
The purpose of this page is to show parents what an Atypical clubfoot looks like
because in the course of their infant's treatment, if they begin to see their
child's foot look like this, then they will have a Light Bulb Moment and say, "Ah
ha! This doctor is making the foot worse than it was at birth!" at which point
they can bid this doctor farewell and seek out a skilled professional while the
baby is young enough to still respond to the non-surgical Ponseti method.
If your baby does have atypical / complex clubfoot, one should avoid the use of
the Markell style foot abduction brace and insist on being given the Mitchell
clubfoot brace instead.
Photos of atypical clubfeet.
| Return to Atypical Clubfeet Top of Page Read more about Brian here. Return to Six-feet.com Home |
| We just found out on Tuesday as my son came out of his last cast and should have begun bracing, that he too has an atypical clubfoot that was not diagnosed or treated properly.
the foot "didn't look bad" but that he may need a second tenotomy down the road. He told us to put the shoes and brace on him over the course of the following week and bring him back in a month. My husband and I didn't think the foot looked right and when the Mitchell shoes would not go on his foot, we called MD Orthopaedics and emailed them pictures of his foot. They said that the foot looked to be atypical and said that it has not been corrected to the point that the shoes will work. I then emailed the pictures to Dr. Ponseti who called me and confirmed that the foot is atypical and recommended we go to Iowa so he can treat my son's foot. Our first appointment is on the September 19th, 2007.
that after 9 weeks of supposed treatment, we are back at square one. together a page on her website dedicated to atypical clubfoot that will show pictures of my son's foot as it is today and its progress as Dr. Ponseti treats it. By the way, the doctor that said the feet "didn't look bad" in the photos at the top of this page, and who did not properly treat my baby's foot is Dr. Klingele at Columbus Children's Hospital in Ohio. We are looking forward to meeting with Dr. P on the 19th and in the meantime, I will enjoy playing with my son's beautiful little feet.... Christina, mom to Alexander (pictured at top of page) |
Brian's Atypical Clubfeet - age 5
months. (You start to understand the
Fred Flintstone joke...)
months. (You start to understand the
Fred Flintstone joke...)
Above: Brian's atypical clubfeet at 2 months
old with no casts on his feet (big red flag!)
Left: Brian at 3 months old, again, with no
casts on his feet. After three whole months
of casting, there was NO excuse for his feet
to still be in this bad of shape!
old with no casts on his feet (big red flag!)
Left: Brian at 3 months old, again, with no
casts on his feet. After three whole months
of casting, there was NO excuse for his feet
to still be in this bad of shape!
Brian at 3 months old wearing
Half-Casts...yet another big red
flag...
Half-Casts...yet another big red
flag...
Brian's Atypical clubfeet more than a year
later, at the age of 20 months... they still look
like they did a year and a half earlier. At this
point, Dr. Buie wanted to start reconstructive
surgery on Brian, and this is when I
discovered Dr. Ponseti and caught an Angel
Flight to Iowa City.
later, at the age of 20 months... they still look
like they did a year and a half earlier. At this
point, Dr. Buie wanted to start reconstructive
surgery on Brian, and this is when I
discovered Dr. Ponseti and caught an Angel
Flight to Iowa City.
| In this photograph of my boys' clubfeet, you can see that Brian's atypical feet in the center still look somewhat different than the non-complex feet of his brothers. All three boys had bilateral clubfeet, but only Brian's were atypical. Parents can expect their child's atypical feet to grow up well and functional but should also prepare themselves that the feet may never look completely "normal" |
Here it is described in the pamphlet
"Clubfoot-Ponseti Management",
"About 2–3% of clubfeet are more
difficult to correct and are
described as atypical. Successful
management of these feet require
special consideration. Most atypical
clubfeet are short and stubby [A].
The skin is soft and the subcutaneous
(under the skin) tissue is fluffy.
The heel is in severe, rigid equinus
and in varus (foot pointing down
and inward). There is a deep crease
above the heel and a thick fat pad
covers the undersurface of the
calcaneus (heel bone). All metatarsals
(long foot bones ) are markedly
plantar-flexed causing a stiff high arch
and a deep transverse crease in the
sole of the foot [B]. The big toe is
short and hyperextended. "
It goes on to describe Dr. Ponseti's
very specific technique necessary
to correct an atypical clubfoot. (It
seems to me, Dr. Ponseti views the
working foot somewhat like a beautiful
machine and he's the world's best
mechanic.) In later chapters the
pamphlet describes common errors in
clubfoot management that result in
more severe deformaties than what the
child was born with.
"Clubfoot-Ponseti Management",
"About 2–3% of clubfeet are more
difficult to correct and are
described as atypical. Successful
management of these feet require
special consideration. Most atypical
clubfeet are short and stubby [A].
The skin is soft and the subcutaneous
(under the skin) tissue is fluffy.
The heel is in severe, rigid equinus
and in varus (foot pointing down
and inward). There is a deep crease
above the heel and a thick fat pad
covers the undersurface of the
calcaneus (heel bone). All metatarsals
(long foot bones ) are markedly
plantar-flexed causing a stiff high arch
and a deep transverse crease in the
sole of the foot [B]. The big toe is
short and hyperextended. "
It goes on to describe Dr. Ponseti's
very specific technique necessary
to correct an atypical clubfoot. (It
seems to me, Dr. Ponseti views the
working foot somewhat like a beautiful
machine and he's the world's best
mechanic.) In later chapters the
pamphlet describes common errors in
clubfoot management that result in
more severe deformaties than what the
child was born with.
| Cuboid Bones Could Be a Direct Link to Relapsing Clubfoot In Many Cases and Often Goes Undiagnosed. Read More About It Here..... |