Clubfoot is one of the most common orthopedic congenital deformities. The deformation is caused when the tendons in the foot develop abnormally and do not reach their full length. Consequently, the feet turn inwards.


A baby with clubfoot


In the Pediatric Orthopedics Department at Shaare Zedek Medical Center, we have accumulated years of experience in treating infants with Clubfoot. We use the Ponseti Method, currently the most commonly used non-surgical method worldwide. Dr. Ignacio Ponseti is a pediatric orthopedic physician from Iowa that developed the serial casts for treating clubfoot.
Treatments are conducted in the clinic (including Achilles tendon extension) according to the accepted treatment protocol. If more extensive surgical treatment is required, it is administered in the operation room with full hospitalization.
The equipment used in the clinic is specifically tailored for children – special padding for the cast, cast types adapted for children and babies, and a suitable environment. The placing of the casts is not painful. Fixing the position of the foot is done gently and gradually. However, we ask parents to make sure that the toes appear normal and that there are no pressure marks or swelling. 

Babies born in Shaare Zedek who are diagnosed with foot problems are referred immediately to the clinic. Their treatment begins soon after birth and the clinic continues to treat and monitor them as they grow.  Babies born in other hospitals are also referred to us, as well as infants with foot problems diagnosed at a later stage.
You are welcome to consult with us about children of any age and about any orthopedic disorder. If we think that the problem does not need to be treated in our clinic we will refer you to the best possible alternative.

We try to examine and treat babies when they are calm. Therefore we open the clinic at times when babies tend to sleep. This usually insures that the baby will be relaxed during the treatment. We recommend that you feed the baby before the examination begins.

At each visit, we methodically examine and grade the state of the feet and measure progress. After the child has been examined and the results and grades recorded, we move to the next stage – manipulation and placing the cast. 
Firstly the foot is gently bent into the new position. We don't attempt to reach the normal state of a healthy foot yet, rather we use a special method to gradually reconstruct the affected joints. That is why even after placing the casts the foot still seems very "distorted," especially in the early stages.
Following the manipulation, we apply a cushioned dressing and then place the cast in the acquired position. The cast runs from groin to toes.



A baby with clubfoot, after applying a cast


After the cast has dried, we cut the end so we can see all the toes. There will be a few lumps (the ends of dressings) in the cast, from which you will be able to begin removing the cast at home after wetting.
The cast may cause itching in the groin area and we recommend folding the edges of the cushioning and smearing skin cream. Please ensure that the diaper is sealed well and acts as a divider between the skin and the cast.
If the baby needs an Achilles tendon extension (an important part of the treatment according to the Ponseti Method), this minor operation will be performed under local anesthesia, in a small operating theater in the clinic, under sterile conditions and according to all regular operative regulations. After this procedure the baby will remain under supervision for an hour.
Once the foot has been fully corrected, the Foot-Abduction Brace (FAB) or Denis Browne Bar/Brace will be installed at the clinic. We recommend a number of orthopedic institutes that supply this device (you need a referral from your HMO in order to receive a refund on the purchase. Each HMO has its own refund regulations.) You can buy the device from any orthopedic supplier but we recommend buying from places that promise to adapt and repair the device if needed. 

At the beginning, we change the cast every week. The visits then become less frequent and at the later stages, once the device is in place, you will be asked to come in once every few months. We recommend monitoring the child until adolescence.
Parents can remove the cast at home. First wet the cast with a wet cloth (you can even bathe the baby with the cast on) and then gently peel the cast in the opposite direction to how it was put on. It is a quick and simple procedure that allows you to forego the normal method of sawing the cast.
After removing the cast, we recommend applying body cream on the baby's feet and massaging them so that the baby gets used to moving them and to renew normal skin stimulation. You can remove the cast on the morning of your appointment or the night before.

In the event of a problem, we recommend you contact the hospital (Pediatric Emergency Department) or call Dr. Karasik or Dr. Lebel via the Operator at the Shaare Zedek Medical Center –972-2-6555111 (ask to be connected.)