Featured Research

from universities, journals, and other organizations

Surgeon Revives Successful Clubfoot Treatment

Date:
January 15, 2005
Source:
Washington University School Of Medicine
Summary:
Almost 60 years after it was conceived, Washington University orthopaedic surgeon Matthew B. Dobbs, MD, has revived a nonsurgical technique to correct talipes equinovarus, or clubfoot, a congenital foot deformity. By combining the venerable procedure with the latest genetic science and translational research, Dobbs aims to drastically improve treatment and perhaps eventually reduce the incidence of the malady.

Matthew Dobbs mixes modern precision with a venerable insight to deliver gentle, successful care for clubfoot.
Credit: Photo courtesy of Washington University School Of Medicine

Dec. 23, 2004 — Almost 60 years after it was conceived, Washington University orthopaedic surgeon Matthew B. Dobbs, MD, has revived a nonsurgical technique to correct talipes equinovarus, or clubfoot, a congenital foot deformity. By combining the venerable procedure with the latest genetic science and translational research, Dobbs aims to drastically improve treatment and perhaps eventually reduce the incidence of the malady.

The revived procedure employs weekly stretching of the infant's foot followed by the application of long-leg casts that gently reshape an infant's relatively plastic foot. Dobbs says the procedure serves his patients well, "The casting technique is applicable to all clubfeet from birth to the age of 2 years."

Ignacio Ponseti, MD, developed this nonsurgical technique to treat clubfeet almost 60 years ago because he saw that children treated surgically for clubfoot often went on to develop pain, stiffness, early onset arthritis, and complications that threatened the quality of their lives, even in their 20s. Dobbs confirmed, with a 25-year follow-up study on surgically treated clubfeet, that indeed many patients had poor foot function by early adulthood. A 35-year follow-up study has been performed on patients treated with the Ponseti technique, which found them to be functioning well, without arthritis. These results called into question the value of the traditional clubfoot surgery: a three- to four-hour operation to release all of the muscles, bones and tendons in the foot and create a reconstruction held in place with metal pins.

In the casting procedure Ponseti developed as an alternative treatment, the first cast is often applied in the newborn nursery, ideally within days of birth. "Ligaments and soft tissue respond to stretch better when we're very young," says Dobbs. The first cast stays in place only a week. Then the surgeon examines the progress and applies a second cast designed to reshape the foot slightly more. After four to five weeks and the same number of casts, the foot is completely corrected.

"It's a visual process. Parents see improvement every week," Dobbs says. It also requires training and great judgment by the surgeon. Although the procedure is endorsed by the Pediatric Orthopedic Society of North America, it still is not practiced widely. Only 25 orthopaedic surgeons are certified in the Ponseti technique nationally.

After casting is complete, young patients must wear orthopaedic shoes and a brace for a number of months, though the procedure usually doesn't interfere with learning to walk. "Compliance with the regimen is essential to success," Dobbs says. If the brace is not worn as prescribed, recurrence is inevitable. Most recurrences can be treated with repeat casting. Those few cases that don't respond to casting can always be treated surgically.

Dobbs has successfully treated children as old as 19 months and now is gradually advancing the age at which the casting procedure can be initiated. Parents of young patients from around the world have learned of the procedure, and 50 percent of Dobbs' practice now comprises pediatric foot deformities.

Interested in learning all he can about clubfoot, Dobbs also is engaged in translational research to identify the genes that play a role in the congenital and hereditary disorder that appears in approximately 1 in 1,000 live births in the United States and perhaps seven times that many children among Pacific Islanders. Grateful patients contribute to his DNA library, and a genome-wide scan has allowed initial localization of the involved gene. Next: narrow down the search to find the specific gene and its protein product to improve prenatal counseling. Ultimately, Dobbs would like to devise gene therapy to eliminate the malformation.

Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.


Story Source:

The above story is based on materials provided by Washington University School Of Medicine. Note: Materials may be edited for content and length.


Cite This Page:

Washington University School Of Medicine. "Surgeon Revives Successful Clubfoot Treatment." ScienceDaily. ScienceDaily, 15 January 2005. <www.sciencedaily.com/releases/2005/01/050110121628.htm>.
Washington University School Of Medicine. (2005, January 15). Surgeon Revives Successful Clubfoot Treatment. ScienceDaily. Retrieved April 19, 2014 from www.sciencedaily.com/releases/2005/01/050110121628.htm
Washington University School Of Medicine. "Surgeon Revives Successful Clubfoot Treatment." ScienceDaily. www.sciencedaily.com/releases/2005/01/050110121628.htm (accessed April 19, 2014).

Share This



More Health & Medicine News

Saturday, April 19, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Nine-Month-Old Baby Can't Open His Mouth

Nine-Month-Old Baby Can't Open His Mouth

Newsy (Apr. 19, 2014) Nine-month-old Wyatt Scott was born with a rare disorder called congenital trismus, which prevents him from opening his mouth. Video provided by Newsy
Powered by NewsLook.com
'Holy Grail' Of Weight Loss? New Find Could Be It

'Holy Grail' Of Weight Loss? New Find Could Be It

Newsy (Apr. 18, 2014) In a potential breakthrough for future obesity treatments, scientists have used MRI scans to pinpoint brown fat in a living adult for the first time. Video provided by Newsy
Powered by NewsLook.com
Little Progress Made In Fighting Food Poisoning, CDC Says

Little Progress Made In Fighting Food Poisoning, CDC Says

Newsy (Apr. 18, 2014) A new report shows rates of two foodborne infections increased in the U.S. in recent years, while salmonella actually dropped 9 percent. Video provided by Newsy
Powered by NewsLook.com
Scientists Create Stem Cells From Adult Skin Cells

Scientists Create Stem Cells From Adult Skin Cells

Newsy (Apr. 17, 2014) The breakthrough could mean a cure for some serious diseases and even the possibility of human cloning, but it's all still a way off. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins