Texas Scottish Rite Hospital for Children
2222 Welborn Street, Dallas, Texas  75219-3993
A new treatment is helping young patients overcome clubfeet.

Photo: Physical therapist Holly Wilson tapes patient Kristen Silva’s foot during treatment at Texas Scottish Rite Hospital for Children, Dallas.
Young Kristen Silva has a lifetime of running, jumping, and playing ahead of her. This probably doesn't seem remarkable, except for the fact that Kristen was born with two severe clubfeet. Clubfoot is an abnormality of the foot where the foot turns in and down at birth. The muscles, tendons, and ligaments supporting the feet are contracted (or shortened), causing the bones in the foot to be out of normal alignment. The severity of clubfoot varies widely from case to case, ranging from deformed but flexible to extremely rigid and difficult to move.

The good news about clubfoot, though, is that it is a highly treatable ailment. Treatment is required shortly after birth. Up until recently, the two most common forms of treatment have been casting and surgery. Serial casting is a process that enables the foot to be stretched to the desired position through a series of plaster or fiberglass casts. After casting, a special brace may be required to help maintain the effects of the casting. Often, though, if casting is not completely successful, or if a child has a severe case of clubfoot, surgery is required.

While casting and surgery are both proven methods of treating clubfoot, a new treatment is also now helping patients at Texas Scottish Rite Hospital for Children (TSRHC), Kristen Silva included. The new technique, pioneered in France, consists of stretching, strengthening, taping, and splinting. The procedure involves daily stretching and massage of the foot, followed by application of tape and a soft plastic splint that is easily removed and put back on. Parents, after training from a therapist, remove the splint each day, perform a specific series of stretching and strengthening exercises with the foot, then reapply the splint. This process, while time-consuming and meticulous, has been quite successful for patients at TSRHC. The French medical professionals who have been utilizing this method for sometime now are reporting significantly fewer surgeries for this patient population.

"The treatment definitely requires a significant time commitment from the families, but the benefits certainly outweigh the inconvenience," Holly Wilson, a physical therapist at TSRHC, says. "We make a big effort to work with these families to make the treatment as convenient as possible. We offer encouragement and try hard to accommodate parents’ schedules and make the treatment process easier."

Karl Rathjen, M.D., an orthopedist at TSRHC, is pleased about the initial results of the new technique but mindful of the fact that no treatment offers the same success for every patient. “Our short-term results with this treatment have been encouraging,” he says. "We also need to remember that this treatment requires substantial time commitment from the family. Most families visit the hospital at least an hour a day for the first month or so until they are comfortable with the stretching and taping themselves. Some families are simply unable to accommodate the demands of this type of treatment. For them, traditional casting and surgery may be the best options for treating the child’s clubfoot."

So far, Kristen Silva’s mom, Lori, is pleased with the progress made possible by the new technique. Kristen’s prognosis for a lifetime of running, jumping, and playing is getting brighter all the time. According to Wilson, "There is a lot of personal satisfaction working with these babies. The feet begin to improve almost immediately, and the parents are eager to learn and happy with the improvements. Also, as physical therapists, we get to follow these patients all the way through their treatment process. It’s really rewarding when we get to work with a child until treatment is complete."