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Medical Edge Newspaper Column from Mayo Clinic

BEGIN TREATMENT FOR CLUBFOOT A WEEK OR TWO AFTER BIRTH

DEAR MAYO CLINIC: I am 22 weeks pregnant. At my last ultrasound, they discovered that the baby has clubfoot. My doctor suggested waiting until the baby is about 3 months old before we do anything. I’ve read that treatment should start soon after the baby is born. What is commonly done in these cases? Should I be looking for a pediatric orthopedist now? — North Dakota

ANSWER: Yes, I’d recommend finding a specialist before the baby is born.
There’s a chance that your baby won’t have clubfoot, a congenital bone deformity that affects one in 1,000 babies. An ultrasound image shows the position of the foot, but it doesn’t show the stiffness of the foot. It could be that the foot will move into place when there’s room.

If the baby has clubfoot, you’ll want to start treatment within one or two weeks after birth. I recommend talking with a pediatric orthopedist who’s experienced in the Ponseti method — well established as the most effective, nonoperative treatment.

Treatment begins with a series of casts. The doctor gently stretches and manipulates the foot to an improved position, and the cast holds the foot in place. Casts are changed about once a week for about five weeks.

After this casting, most children require a release of the Achilles tendon, a small procedure that’s done with local anesthetic in the office or clinic. Then a final cast is applied, which remains in place about three weeks.

After casting is done, the child wears a brace 23 hours a day for the next six to nine months. The brace holds the foot in a corrected position. At about 9 months of age (about the age when the child might start walking), the brace is worn only at night. Bracing is critical to prevent the foot from returning to the clubfoot position.

The treatment works well. Approximately 80 percent of children treated with this method avoid the traditional major surgery to correct clubfoot. (Before this treatment approach was developed, about 80 percent of children with clubfoot had major surgery to correct it.)

Children successfully treated for clubfoot deformity do all the typical activities of childhood: walk, run, play and participate in community sports.

— Anthony Stans, M.D., Orthopedics, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Clubfoot
Appointment Information
More Information on Clubfoot

READERS: Food provides energy for your body to function. Eating the right foods also can help ward off illness. Here are some “gotta have” foods for good health.

Whole grains: Choose bread or cereal that has whole wheat, whole-wheat flour or other whole grains as the first ingredient on the label. Don’t be fooled by the words “wheat bread” or “wheat flour.” Look for the word “whole.” Eating whole grains may lower your risk of cardiovascular disease, type 2 diabetes and cancer.

Fish: Nutritionists recommend that you aim for at least two, three-ounce, cooked servings of fish a week. If possible, go for fish such as salmon and tuna. They are rich in omega-3 fatty acids, which may protect against heart disease.

Walnuts and almonds: Nuts are nutrient dense and naturally cholesterol free. Studies suggest that they may even help reduce low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — and thus reduce your risk of a heart attack.

Plant stanols or sterols: Margarine-like spreads such as Benecol and Take Control contain added plant stanols or sterols, natural substances from plants that help block the absorption of cholesterol. When used as directed in place of other fats, they can decrease LDL by up to 14 percent.

Soy: Regular soy in your diet may reduce your cholesterol and lower your risk of cardiovascular disease. Try soy burgers or soy dogs instead of meat. Snack on soy yogurt or roasted soy nuts.

Fat-free dairy products: Skim milk and fat-free cottage cheese, yogurt and cheese can contribute to preventing high blood pressure, stroke, colon cancer and obesity.
Berries: Berries are rich in antioxidants that may lower cancer and cardiovascular disease risk.

Broccoli and cauliflower: These and other cruciferous vegetables — cabbage, Brussels sprouts, bok choy and kale — have naturally occurring phytochemicals that may help reduce the risk of colorectal and other cancers.

Additional Resources:
Eating Healthy is Easier Than You think

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.