This website will present the developments of the Clubfoot project, part of the Symbionics project in the faculty of CTW.
Clubfoot (talipes equinovarus) is a common congenital deformity and often treated with the Ponseti method. To correct the adductus deformity, the orthopaedist applies manual pressure on the medial side of the first metatarsal with counter pressure on the lateral side of the talar neck, abducting the foot while aligning the talus with the calcaneus. This manipulation stretches the tissues on the medial side of the foot and is maintained for a week with a plaster cast. Most cases of clubfoot are corrected after five to six cast changes and, in many cases, a percutaneous Achilles tenotomy. After the casting period a foot abduction brace is used for four years to prevent relapse.
We have measured the applied forces on the clubfoot during the Ponseti method (Giesberts, et al. (2017) Quantifying the Ponseti method). Our main observation in this measurement were the great differences between practitioners. The measured pressure of the cast on the instrumented foot would probably cause skin problems in real life but this is rarely observed in real life. A possible explanation could be that the foot adapts very rapidly, which decreases the pressure on the foot.
In our current measurement we place force sensors on the clubfoot to assess the forces in the Ponseto method. Our preliminary results show that the initial forces decreases exponentially to reach an equilibrium within hours after casting. These findings suggest that most of the correction is done long before the end of the week and treatment could be accelerated drastically.
Despite the Ponseti method being the ‘gold standard’, the toe-to-groin plaster cast hinders normal leg movement and makes bathing and maintaining child hygiene difficult. Current study aims to develop a dynamic brace as a more efficient and more user-friendly alternative. To do so, pressure measurements are done to objectify the Ponseti method and to find possibilities for improvement. After these measurements multiple concepts for dynamic braces are developed and prototypes are tested in a clinical setting.
Some additional information can be found on ResearchGate.