Project Clubfoot

This website will present the developments of the Clubfoot project, part of the Symbionics project in the faculty of CTW.

PhD Student: Bob Giesberts
Supervisor: ir. E.E.G. Hekman
Promotor: G.J. Verkerke

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.

Magnetic Resonance Imaging comparing tarsal bones before and about ten minutes after casting shows immediate shape changes to the cartilage anlagen. Our preliminary measurements show that the initial cast/foot interface pressure of 2 – 10N at the first metatarsal and 10 – 15N at the talar neck both drop to zero about an hour 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, extensive pressure measurements are scheduled to first objectify the Ponseti method and to find possibilities for improvement. After these measurements multiple concepts for dynamic braces will be developed and prototypes will be tested in a clinical setting.