Medical:

Casting- A series of plaster or fiberglass casts are applied to the foot and lower limb – these are replaced
every few weeks, which each cast progressively moving the foot towards a more corrected position. The
number of times the cast needs to be replaced will be determined by the severity of the clubfoot (but
several months is not unusual). Most activities are not hampered by wearing a cast.

Botox- Botox is also being used as an alternative to surgery. Botox is the trade name for Botulinum Toxin
type A. a chemical that acts on the nerves that control the muscle. It causes some paralysis(weakening)
of the muscle by preventing muscle contractions (tightening). As part of the treatment for clubfoot,
Botox is injected into the child’s calf muscle. In about 1 week the Botox weakens the Achilles tendon.
This allows the foot to be turned into a normal position, over a period of 4–6 weeks, without surgery.

The weakness from a Botox injection usually lasts from 3–6 months. (Unlike surgery it has no lasting
effect). Most club feet can be corrected with just one Botox injection. It is possible to do another if it is
needed. There is no scar or lasting damage.

Surgical:

 Soft tissue surgery that releases the tight tissues around the joints and results in lengthening of
tendons so the foot can assume a more corrected position
 Bony procedures such as “breaking bone” and resetting the bone to correct deformities, or
fusing joints together to stabilize joints to enable the bones to grow solidly together.
 Tendon transfers to move the tendons to a different position, so they can move the foot into a
corrected position.

Stripping of plantar fascia-

Tenotomy- A tenotomy is a surgical act which involves the division of a tendon. When it involves the
Achilles tendon, it is called a "Achillotenotomy". It has been used in the treatment of cerebral palsy. It
has also been used for hammer toe.

For severe cases:

Wedge resections-

Osteotomy- An osteotomy is a surgical operation whereby a bone is cut to shorten, lengthen, or change
its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has
healed crookedly following a fracture. It is also common when there is a deformity caused by either a
disorder or a disease.

Astragalectomy- sometimes called a talectomy is a surgical operation for removal of the talus bone
(astragalus) for stabilization of the ankle. Historically, an astragalectomy was used in cases of severe
ankle trauma and congenial talipes equinovarus (clubfoot). Presently, it is not a common operation,
however it still used in cases of a deformed calcaneus, foot paralysis following poliomyelitis, and also
rigid clubfoot deformities that are secondary to spina bifida or arthrogryposis (AMC). The surgery is also
performed in severe cases of pulverized or infected open fractures.

Nursing Interventions:

-encourage exercise after clubfoot correction to maintain proper foot alignment.

- apply night splint for immobilization.

-encourage wearing orthopedic shoes.

- stimulate movement of toes to promote circulation.

- elevate the extremity to promote venous return and prevent edema.