Melanie Cole, MS (Host): Clubfoot occurs in about one of every 1,000 births. My guest today is Dr. Peter Smith. He’s a pediatric orthopedic surgeon at Shriners Hospitals for Children – Chicago. Dr. Smith, let’s start with a little education. What is clubfoot? Is it typically one foot or two? How does it happen?

Peter Smith, M.D. (Guest): Well, clubfoot is a congenital condition. Children are born with this. It’s not preventable as such. We don’t exactly know what causes it. About half the time, both feet are involved. It involves a twisting inward of the foot and it’s a condition where the foot is stuck in that position when the children are born that way. Although it isn’t preventable, it is highly treatable.

Host: Is it generally diagnosed before birth, or only the baby’s born?

Dr. Smith: Yes, it can be diagnosed at the time of birth. We do get calls from parents where this has been diagnosed by ultrasound. We can tell them that after the baby’s born and is healthy for several weeks, then they can bring the baby to us and we can start the treatment.

Host: Then let’s talk about the goal of treatment. Is surgery always the best option? Speak about the treatment options that are available, and your approach with the Ponseti method.

Dr. Smith: Yeah that’s an interesting question because in the past, it was felt that surgery was the best treatment. But now, we know a lot more about ways to treat the foot without a big surgery. We've perfected a method of casting called the Ponseti method where casts are placed after stretching the foot and we change then every week. We place these casts on and then gradually the foot becomes into a corrected position. Then we use a brace to hold it in that position. We’ve found that that’s very effective. Not only in straightening the foot but getting better results even as adults over the surgical method.

Host: I imagine, Dr. Smith, one of the questions parents would have when you mention this method of casting. Is it painful for the child?

Dr. Smith: That’s a good question too. No. This is not a forceful manipulation. When we teach this method all around the world, one of the things that Dr. Ponseti taught was that children really shouldn’t be crying to screaming in pain. This is something that’s a gentle manipulation of the foot, and then we put the foot in a position of as much correction as we can get. But no. It’s not a painful condition. It’s a little bit uncomfortable for families to manage the casts to keep things clean, but in general, it’s much more effective in the long run, like I said, that more extensive surgical treatment.

Host: Speak about the parents then a little bit as you said it could be uncomfortable in caring for the cast and what their role is. Tell us what the parent’s role and what results they can expect.

Dr. Smith: Well, they just need to bring the child to see us every week while they're undergoing the casting. Obviously, that’s sometimes an imposition. They have to travel to see us. After that visit, these kids and families do really well. There’s some compliance that we need after the casts come off. They're in a brace that holds the feet apart at night time; but all of that is well worth it so that by the time the children are walking, their feet are flat on the ground. They're wearing regular shoes. It’s one of the more satisfying conditions that we treat.

Host: You have an excellent team Dr. Smith. Tell us about your team approach and why this type of approach at Shriners is helpful for children and their parents with this condition.

Dr. Smith: Yeah. So, at Shriners we’re able to, first of all, do a complete evaluation of the child. Sometimes children with club feet have other conditions associated with that. For example, contractures of the knees or hips or upper extremities. So, we can do a full evaluation and treat the whole child. Then when they're going through the casting, we have an excellent cast room with technicians. We have nurses and child life specialists that help us to make sure the children are as comfortable as they can be. We have an excellent network of nurses and other medical professionals to help parents with whatever questions they have.

Host: Now tell us about your studies about long-term outcomes? Comparing these methods as we spoke about. That surgery is not really what’s mostly recommended anymore, and your Ponseti method is effective and really helps the children. Tell us about some of the studies that you’ve done.

Dr. Smith: Yeah. So, our hospital and other hospitals a long time ago were centers of expertise, if you will, in the surgical correction of clubfoot. The results actually were quite good. However, now we realize that as we look at adults and we have a motion analysis laboratory that analyzes gait and motor function and strength and other aspects of how people live and are mobile with feet. We looked at two populations. Adults that had clubfoot that had surgery and others that had treatment with the Ponseti method. Clearly the Ponseti method adults, those who had been treated in that fashion, did much better as adults. They had less pain, able to do more activities. So, we were pleased that that corroborated our impression that this was a better method.

Host: This is an international issue, yeah. So, tell us about that and how your efforts have helped around the world physicians dealing with children with clubfoot.

Dr. Smith: Oh, thanks for asking. So, we know that this is one of the most common musculoskeletal conditions. Like you said, about one in a thousand. So that means there are hundreds of thousands of babies with clubfoot that need treatment. Obviously, not that many of them have access to the facilities that we have. But with the casting methods, this can be taught all over the world. With lots of other pediatric orthopedists in different types of venues, we've done teaching in the methods of this. We teach it to doctors. We teach it to physical therapists and other health professionals in other countries. Generally, in the form of conferences and lectures and demonstrations. So that our hope is that this will be adopted all over the world as the treatment for this common deformity that if left untreated becomes somewhat disabling. But with a relatively simple treatment with casting, can result in relatively normal looking feet that function well and don’t result in disabilities. So, it’s our hope that this method will be available all over the world. And there’s many people working on that, among them many of the Shriners doctors.

Host: Dr. Smith, how is your inhouse prosthetic service involved in this treatment, which families can choose to utilize if they wish. Yes?

Dr. Smith: Yeah. We have inhouse orthotics and prosthetics. The orthotics that is used for this is a brace that holds the feet apart. It can be fit by our orthotist. As the children go on, some of them need other kinds of braces and shoe inserts to help with their function. We can do that too. So yes, they're a part of our team.

Host: Wrap it up for us Dr. Smith. This very common condition, but as you stated could be disabling if not treated. Just give parents listening your best advice and what you’d like them to know about clubfoot and the treatment that you can provide at Shriners Hospitals for Children – Chicago.

Dr. Smith: Yeah. I would say that it seems like a complicated problem, and it does require a lot of attention to detail. With the proper treatment with casting, usually we can get the foot in an excellent position. The children can have great function. What I tell the parents is that their children usually can do all the things that other kids do as they're growing up and even as adults. That’s definitely our goal.

Host: That’s excellent Dr. Smith. Thank you so much for coming on and explaining with your expertise the treatment options available and that it’s far less complicated for the parents to understand than they might realize. So, thank you so much for speaking about the treatment options available for clubfoot. This is Pediatric Specialty Care Spotlight with Shriners Hospitals for Children Chicago. For more information, please visit shrinerschicago.org. That’s shrinerschicago.org. I’m Melanie Cole. Thanks so much for tuning in.