Introduction

Congenital clubfoot (talipes equinovarus) is a common pediatric foot deformity that, when treated early and correctly, has an excellent prognosis. This guide summarizes internationally accepted approaches, practical day‑to‑day care and rehabilitation guidance specifically aimed at families in Saint‑Petersburg, Russia. It is intended as an overview — always follow the individualized plan from your pediatric orthopaedic specialist and rehabilitation team.

*Quick note:* Seek evaluation as soon as possible after birth. Early treatment is simpler and more effective.

What is clubfoot?

Clubfoot is a complex three‑dimensional deformity of the foot that typically includes:
— forefoot adduction (turned inward),
— hindfoot varus (heel turned inward),
— ankle equinus (downward pointing foot).

It can be idiopathic (isolated) or associated with neuromuscular or syndromic conditions. A specialist will check for other anomalies and decide if further investigation is needed.

Internationally accepted treatment approaches

— Ponseti method (gold standard)
— Serial gentle manipulation and plaster casts changed weekly to gradually correct alignment.
— Percutaneous Achilles tenotomy (small outpatient procedure) is commonly performed to correct residual equinus.
— Final maintenance with abduction brace (boots and bar).
— High success rates when started early and when brace protocol is followed.

— French functional method
— Intensive daily physiotherapy, taping and splinting, usually performed by specialized PTs.
— Requires strong parental involvement and access to experienced therapists.

— Surgical treatment
— Reserved for resistant, neglected, or very severe cases, or when non‑operative methods fail.
— Procedures vary from tendon lengthenings to posteromedial release; long‑term functional outcomes depend on timing and extent of surgery.

Typical timeline (Ponseti method)

— Start: ideally in first weeks of life.
— Casting: weekly for about 4–6 weeks (varies by case) to correct foot position.
— Tenotomy: often performed near the end of casting under local anaesthesia/sedation.
— Final cast: 2–3 weeks post‑tenotomy to allow tendon healing.
— Bracing phase:
— Full‑time wear (about 23 hours/day) for 2–3 months.
— Then part‑time (naps and nights) until ~4–5 years of age to prevent recurrence.
— Follow‑up: regular checkups through early childhood to monitor growth and gait.

Practical care for parents — what to expect and how to prepare

— Before the first appointment:
— Bring the child’s neonatal and pediatric records.
— Prepare questions: timing, method recommended, cast/brace schedule, pain management, follow‑up plan.
— During casting:
— Casts are usually comfortable for infants; they may cry due to handling.
— Expect weekly clinic visits for cast changes.
— After tenotomy:
— Minor procedure; follow post‑op wound care instructions and keep the final cast dry.
— Brace care:
— Use soft cotton socks under the brace.
— Check skin twice daily for redness, sores or irritation; report concerns promptly.
— Clean the brace per instructions (wipe surfaces; avoid soaking unless specified).
— Hygiene and comfort:
— Sponge baths are recommended while the child is in a cast.
— Use distraction (feeding, toys, parent holding) during manipulation and procedures.

Home rehabilitation and exercises

Always perform exercises exactly as taught by your physiotherapist. Typical elements:

For infants (daily, several sessions):
— Gentle stretching:
— Hold the heel and forefoot; use gentle, sustained stretches into abduction and dorsiflexion (several seconds), repeated 5–10 times.
— Avoid forceful, rapid pulling.
— Range of motion play:
— Gentle cycling movements with legs, encouraging symmetrical motion.
— Massage:
— Light kneading and stroking of calf muscles and foot to encourage circulation and reduce stiffness.

For toddlers and older children (post‑brace or post‑surgery):
— Strengthening:
— Supported heel raises, standing on toes then lowering slowly