The early stages of treatment are part of an intensive process that involves commitment by both the family and the health care team to achieve and maintain optimal results. This section provides an overview of the correction process 
...or suppleness, of the tissues at that age. At each weekly visit, your baby’s foot will be gently manipulated to stretch the short, tight ligaments and tendons of the ankle and foot. The foot is then held in progressively corrected positions by a cast that extends from toes to groin. The cast holds the correction obtained by the manipulation. The time in the cast relaxes the tissues for the next weekly manipulation. Gradually, the displaced bones and joints are brought into correct alignment. Casting corrects all the parts of the clubfoot except equinus, the downward pointing of the ankle. Equinus is corrected with the release of the Achilles tendon (called an Achilles tenotomy), and application of the last cast.

Straightening the foot

Ideally, treatment begins during the first few weeks of life to take advantage of the favorable elasticity..
To achieve good ankle motion, a minor procedure called an Achilles tenotomy is usually necessary to release the Achilles tendon and complete the correction. The tenotomy is a safe, short procedure for your baby, and is usually performed in the outpatient clinic under a local anaesthetic. The tenotomy creates a gap in the tendon, which then heals, resulting in a longer tendon with greater flexibility. The skin incision is very small and no stitches are needed. The ankle and foot are then casted for about three weeks in the fully corrected position.

Achilles Tenotomy 

In a clubfoot, the Achilles tendon is particularly thick and stiff making it resistant to stretching. 
To prevent relapse, your doctor will prescribe a brace to hold the foot or feet in the corrected position after removal of the last cast. The brace is worn 23 hours per day for two to three months, allowing an hour for brace-free bathing and cuddling, and then during nighttime and naps until the child is approximately four years old. Sometimes the duration of brace wear will vary (up to six years of age) depending on the severity of the clubfoot and its tendency to relapse. This will be determined by your doctor as your child grows. The brace, called a foot abduction brace because it “abducts” or rotates the foot or feet outward, looks like two shoes connected by a bar. This simple design is effective in holding the feet in the corrected position. Normal shoes are fine for the child to wear when not wearing the brace. The foot abduction brace is the only brace that prevents relapse and is over 90% effective, if used as prescribed. Wearing the brace will not significantly delay your child’s development with regard to sitting, crawling, or walking. However, NOT wearing the brace will significantly compromise the correction of the clubfoot or feet.

Bracing

Clubfeet have a stubborn tendency to relapse, or come back, after casting correction. 
Have your child’s foot or feet checked regularly by your health care team to watch for relapse, and to detect and manage slight differences. Follow up is rarely needed after the bones stop growing – at around age fourteen for girls and age sixteen for boys. Your doctor will advise you about the follow up schedule. Sometimes surgery is recommended if leg-length differences become bothersome or painful. Some doctors supplement treatment with physiotherapy. Appropriate exercises may be useful additions in preventing relapse, particularly if muscle imbalance within the foot is a problem. If you need help with an exercise program, a physiotherapist with paediatric experience can help gear exercises towards the age and interests of the child. Once correction is complete, foot orthotics, supporting devices or insoles to control joint motion, may be useful to help balance the forces that go through a corrected clubfoot and to make up for slight differences in foot size or leg length that may appear as the child grows. Orthotics and braces need to fit correctly, like shoes, and will need changing at regular intervals depending on how fast the feet are growing. The cost of orthotics and braces are covered by most extended health care benefit plans.

Follow Up and Supplemental treatment

As your child grows, you may notice and be concerned about a slight difference in leg length and foot size.