Watch this before you read anything else

You have just been told your baby has clubfoot, and the next thing most people do is search, which is how they end up looking at photographs of untreated feet from another era. Eight minutes here will orient you better than an evening of that. Then work forward through the weeks below, one at a time.

Written by Heath, who has lived it: casts from birth, a fusion at sixteen, the US Army, and distance running.

What clubfoot is, what treatment involves, and what the realistic outcome looks like. No stock footage of feet you will wish you had not seen.

What happens next

The first months, in order

Not the whole eighteen years. Just the next stretch, so there is something to hold on to.

Today, and the next few days

Nothing needs deciding today. Clubfoot is one of the more common congenital differences, the treatment is well established, and starting a week or two after birth instead of on day one changes nothing about the outcome.

The useful things to do now are small: arrange to see a Ponseti provider, write down the questions as they occur to you, and deliberately stop searching for images. Almost everything alarming online shows untreated feet, often from settings without access to care, and none of it is your child’s trajectory.

Clubfoot and SSI for children → Prenatal clubfoot diagnosis → Carriers for a baby in boots and bar → What the first weeks feel like → Why it happened, and what did not cause it → Shoes for the free hours →

The first appointment

A clinician examines your baby, assesses how severe and how rigid the foot is, checks whether anything else is going on, and sets out the plan. You should leave able to explain that plan to somebody else. If you cannot, ask again before you go.

Worth asking: is this isolated, how many casts do you expect, and who do I contact between appointments. Worth taking: any scan reports, and a written list of questions, because you will forget half of them otherwise.

What the visit involves → Finding a Ponseti provider →

The casting weeks

A series of casts, usually changed weekly, each one holding the foot slightly further into a corrected position. Most babies need somewhere around five to eight, and the whole phase commonly runs about six to eight weeks.

Babies tolerate this far better than parents do. A newborn in a cast is generally a perfectly content newborn, and the distress in a casting room is overwhelmingly in the adults. Most families say it becomes routine by about the third visit.

The casting schedule → What casting day is like →

The tenotomy

Most babies need a small procedure at the end of casting to release the heel cord, which is the last structure holding the foot down. It is quick, usually done under local anesthetic in clinic, and followed by a final cast for about three weeks while the tendon heals.

The word procedure alarms people considerably more than the thing itself warrants. It is a small cut through a tight tendon that then regrows at its new length, and it is a routine part of the method, not a sign anything went wrong.

What actually happens →

Boots and bar (the part that decides it)

After casting comes bracing: boots attached to a bar, worn full-time at first and then at night and naps for several years. This is the longest phase, the least dramatic, and by a distance the most important.

Casting achieves the correction in weeks. Bracing is what holds it, and relapse rates climb sharply when the schedule slips. Families arrive braced for the casting, which is the straightforward part, and are usually caught out by the bracing, which is the part that actually determines how things go.

The bracing guide → When the brace is a fight →

The three things worth hearing tonight

You did not cause itNot by anything you did, took, ate or failed to do. It forms early, through mechanisms still not fully understood.

It is treatable, and treatment worksMost children treated early run about indistinguishably from their classmates. That is the ordinary result.

Your child will not remember any of itCasting, the tenotomy and early bracing all happen well before lasting memory forms.

What children absorb later is not the treatment. It is how the adults around them framed it. As a fact about their body, or as a tragedy that happened to the family. That part is genuinely yours to decide, and it matters more than most of the clinical decisions ahead of you.

The frightening images you found are of feet nobody treated. That is not the road your child is on.

Written by someone who was that baby

I was born with bilateral clubfoot in the era before Ponseti casting was standard, so I had serial casting, bracing and extensive surgery. I walk, I served in the military, and I run distance. A child treated by casting today starts from a considerably better position than I did.

That is the perspective this whole site is written from: not a clinician telling you it will be fine, but somebody four decades down the road telling you what it was actually like, including the parts that are harder than the leaflets say.

The longer version → What the decades actually look like →

Just diagnosed

What should I do first after a clubfoot diagnosis?

Arrange to see a Ponseti provider, write down your questions as they occur to you, and stop searching for images. Nothing needs deciding today, and starting treatment a week or two after birth changes nothing about the outcome.

How long does clubfoot treatment take?

Casting is usually five to eight casts over roughly six to eight weeks, followed by a tenotomy for most babies and a final cast. Bracing then continues for several years, and that phase is what determines whether the correction holds.

Does casting hurt my baby?

Babies generally tolerate it well and are usually content in a cast. The distress during casting appointments is overwhelmingly in the adults, and most families find it becomes routine by around the third visit.

What is a tenotomy?

A small release of the tight heel cord at the end of casting, usually done under local anesthetic in clinic and followed by a final cast for about three weeks. It is a routine part of the method and not a sign anything went wrong.

Which part matters most?

Bracing. Casting achieves the correction in weeks; the boots and bar hold it, and relapse rates climb sharply when the schedule slips. Families usually worry about the casting and get caught out by the bracing.

Will my child be able to run and play sport?

Almost certainly. Most children treated early participate fully and are indistinguishable from their classmates in a playground. The affected foot is often slightly smaller with a thinner calf, which is a difference, not a limitation.

Sources

Where this comes from

1 Clubfoot overview and treatment contextAAOS OrthoInfo 2 Diagnosis and treatment of idiopathic congenital clubfootAmerican Academy of Pediatrics 3 Clubfoot symptoms and causesMayo Clinic 4 Clubfoot diagnosis and treatmentMayo Clinic 5 Club foot overview and Ponseti treatment stagesNHS

Keep going

Where to next

The first weeks →Routed to whichever stage you are actually at. Early treatment →Casting, tenotomy and bracing in full. More videos →The rest of the video library.