CLEFT FOOT

QUESTIONS AND ANSWERS

Cleft Foot Causes

Most experts agree that cleft foot has a hereditary basis. Ectrodactyly, often known as the split hand-split foot deformity, can occur by itself, in conjunction with a cleft hand, or as a component of a hereditary disease. A cleft foot has no recognized cause, thus there are no surefire techniques to stop it from happening. However, by refraining from smoking or drinking throughout your pregnancy, you can lessen the possibility that your baby will incur a foot problem at birth.

Cleft Foot Diagnosis

The formation of the foot’s bones during fetal development causes a cleft foot. Occasionally, the doctor may see this problem during a regular prenatal ultrasound. The abnormality becomes apparent after birth. Typically, an X-ray and physical examination are used to confirm the diagnosis’s specifics. In order to determine what is present or absent, normal or abnormal, your child’s doctor at Medical City Children’s Orthopedics and Spine Specialists will carefully examine every anatomic structure of your child’s foot. Our doctors will examine your child’s foot, including its ligaments, blood vessels, nerves, and muscles. Our doctors will look for further concomitant malformations or syndromes if they determine that your child has a cleft foot.

Cleft Foot Treatment

Without therapy, a cleft foot will not get better. The danger of difficulties later in life rises if the foot is left untreated. In the weeks following birth, treatment is administered. The goal is to make the feet pain-free and functioning. Physiotherapy is a crucial component of any treatment plan. Once the infant is 3 months old, it could start. The therapist may tape the troubled foot in addition to manipulating it. In milder circumstances, this may achieve success. In order to continue the treatment at home, parents might learn these methods.

Bracing

A cleft foot is prone to recurrence even after successful casting repair. Your child will require wearing a brace, usually referred to as “boots and bar,” for a number of years in order to guarantee that the foot will remain in the proper position forever. The brace maintains the correct foot angle so that the correction may continue. For parents, this bracing approach appears demanding, but it will stop relapses.

Your infant will wear the brace virtually constantly for the first three months (23 hours a day). Your physician will progressively reduce the time your child spends wearing the brace to simply overnight and during naps (about 12 to 14 hours per day). The majority of kids will wear braces for 3 to 4 years. There are several varieties of braces, but they always include shoes, sandals, or other specially manufactured footwear fastened to the ends of a bar. When both legs move together, the bar is solid (each leg moves independently). Your doctor will discuss the appropriate sort of brace for your baby’s requirements with you.

Babies may cry a lot the first few days while wearing a brace because they need time to get used to it. These therapy sessions are generally carried out by a physical therapist for the first three months. This is when the majority of the improvement happens. Parents will be trained during this period so that they can perform some treatments at home. Taping and splinting continue until the child is two years old. If the infant’s only problem is bilateral separation, treatment is usually completely successful. Even if the problem is not completely resolved, the appearance and function of the foot are significantly improved.

Conservative Treatments

If alternative treatments fail, our doctors may suggest surgery, although this is often case-by-case. Surgery aims to align the tendons, ligaments, and joints of the foot and ankle by loosening the Achilles tendon or moving the tendon that runs from the front of the ankle to the inside of the foot. More invasive surgery exposes the soft tissue structures of the foot. The surgeon then stabilizes the foot with nails and a cast. Surgery can cause overcorrection, stiffness, and pain. It is also associated with subsequent arthritis.

Surgery

Not all children need ankle surgery. If your child has good foot use and the deformity is not too severe, parents should put surgery on hold while continuing to monitor the child. However, if your child’s foot has serious functional or cosmetic problems, your doctor may recommend surgery. If the malformations of the cleft foot are progressive (will become worse over time), such as syndactyly (joining) between the toes or transverse bones between the fingers, surgeons will operate on the kid as soon as possible. If there is no progressive deformity in the separated foot, the child can have surgery when she is 1 or 2 years old.

When surgery is needed to repair a cleft, the surgeon has a variety of approaches at his or her disposal. The timing and sequence of procedures vary from child to child, but generally, the first procedure is usually done at or after the child is 1 or 2 years old when the child can tolerate anesthesia and surgery well. In general, the goals of operations are:

• Make sure your youngster can utilize his foot properly and seal the cleft.
• Rearrange the soft tissue and skin.
• reposition or stabilize the foot bones

The primary objective of surgery is to enhance foot functionality. The second objective is to make the foot look and feel better, ideally before the youngster realizes that their foot is different from other kids’ feet. The likelihood that the youngster can wear inexpensive off-the-rack shoes as opposed to pricey custom-made shoes improves with surgical foot contouring. The soft tissue, such as ligaments and nerves, must also be taken into account by the surgeon while planning surgery in addition to the foot’s bones.

After Surgery

Your child will stay in a pin-stabilized cast for four to six weeks following surgery. After this time, the doctor can remove the cast and pins without sedation in the office. To preserve alignment and aid with scar reduction, your kid will put on a splint before night for a few weeks. Until she develops flexible active motion and developmentally appropriate foot usage, she will get occupational therapy. The doctor will check on her progress every month throughout this period. Once they finish growing, the doctor will check up with them yearly. The quality of your child’s foot reconstruction is highly dependent on how severe the original deformity was.

You may anticipate that after surgery, your child will have a functioning foot and an aesthetic improvement. Toe alignment ought to also get better. The split foot of your child won’t heal on its own. After receiving treatment, your child’s foot should be practically normal, allowing him or her to run, play, and wear regular shoes. Usually, one to one and a half size smaller and slightly less mobile than the typical foot.  Your youngster may complain of “sore legs” or become fatigued earlier than classmates because the calf muscles of their cleft foot leg will continue to be thinner. A little difference in length between the afflicted and unaffected legs is possible, although this is rarely a serious issue.

Make an Appointment with Medical City Children’s Orthopedics and Spine Specialists

We specialize in children and medical conditions affecting their feet including Cleft Foot.  We have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. Our doctors Shyam Kishan, Richard Hostin, and Kathryn Wiesman have spent years studying children’s health and have devoted their lives to treating them. We welcome new patients and invite you to call us for an appointment for your child.

____________________

Footnote:

National Library of Medicine: Cleft Foot