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FEBRUARY 28, 2008 —Clubfoot is a relatively common birth defect that occurs in up to 200,000 children every year. While no one knows what causes clubfoot, experts believe that it may be a combination of both genetic and environmental factors.
“Clubfoot results from the abnormal development of the muscles, tendons, bones and blood vessels in fetus during pregnancy,” explains Kimball Medical Center foot and ankle surgeon Gerald Mauriello, Jr., D.P.M., M.A., of the Garden State Foot & Ankle Group in Lakewood. Dr. Mauriello and his associates treat a host of foot and ankle disorders, including clubfoot.
“In general, babies born with clubfeet have unusually short, contracted tendons on the inside and the back of the feet with overstretched structures on the outside of the foot. This causes one or both feet to be pulled in a position with the toes pointing down and in,” he adds. In about 50 percent of cases both feet are affected, and it occurs twice as often in boys.
According to Dr. Mauriello, treatment for clubfoot begins as soon as possible after birth. “While it depends on the severity of the deformity,” he explains, “we typically begin with a more conservative approach and move forward from there.” Treatment, he notes, initially involves manipulating and stretching the foot, coaxing it into position and then casting it on a weekly basis to slowly and deliberately attempt to correct the deformity.
This treatment technique is known as "The Ponseti Method," named after Ignacio Ponseti, M.D., a professor of orthopedics and rehabilitation at the University of Iowa, who developed the treatment some 50 years ago. Dr. Mauriello, who built his practice around the care and treatment of foot and ankle disorders, met with Dr. Ponseti in Iowa. He trained with Ponseti’s team to learn the method and now plans to use it to help patients in this area with clubfoot as well as other similar or related foot disorders.
“Manipulating the newborn foot and casting it in position every week or so allows us to take advantage of the elasticity of the tissues that form the ligaments and tendons in the foot, stretching those structures that need to be elongated, and allowing structures that need to contract, to do so,” he says. “For most infant patients, the deformity can usually be corrected in a matter of six to eight weeks.”
Approximately 5 to 10 percent of patients with clubfoot are not helped by the manipulation and casting. For these patients, surgery is necessary to correct the deformity.
“The surgery involves lengthening some of the tendons and releasing tight ligaments to place the bones and joints in normal positions,” says Dr. Mauriello. “The foot is then casted in the proper position while it heals.” Eventually, he notes, bracing may be needed to keep the foot in position and physical therapy can help improve function and flexibility.
While the condition is not painful, if clubfoot is not treated or is poorly managed it can lead to a host of long-term complications, pain and physical disabilities. “It’s a debilitating deformity,” he explains. “Individuals learn to walk on the outside of the foot. They develop an abnormal gait which can lead to joint wear and chronic arthritis, and often suffer from serious skin infections and ulcerations because they’re walking on a part of the foot that’s not designed for that kind of wear,” he adds.
Known as ‘residual clubfoot,’ this condition occurs frequently in developing countries where eighty percent of the clubfoot cases occur. Residual club foot, according to Dr. Mauriello, requires major corrective surgery.
While locally, the incidence of clubfoot is relatively low, it’s comforting to know that the specialized care and treatment needed to correct this condition when it occurs is available at Kimball Medical Center in Lakewood. To contact Gerald Mauriello, D.P.M, or for a referral to another podiatrist affiliated with Kimball Medical Center, please call 1-888-SBHS-123.
Kimball Medical Center is an affiliate of the Saint Barnabas Health Care System, the largest integrated health care delivery system in New Jersey. Located in Lakewood, Kimball Medical Center is a fully accredited, 350-bed facility offering the most advanced, ultra-modern diagnostic and treatment services. Kimball offers comprehensive rehabilitative services featuring The Balance Center and an advanced sports medicine program. Kimball is also the recipient of the Magnet Award for nursing excellence. The Center for Healthy Living at Kimball offers a wide variety of programs and services for area families, children and seniors, including community education programs, support groups and school based initiatives.
CONTACT: Kristine A. Brown
Director of Public Relations
(732) 557-3902
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