1. Early non-surgical treatment
(1)ponse ti Orthopedic Method: At present, it has been affirmed all over the world, and the specific treatment methods are as follows:
1) manual massage plaster fixation (Ponseti plaster fixation): suitable for children under 1 year old. The deformed components are corrected one by one according to certain procedures, and then fixed with plaster mold (usually fixed for 4-6 times in outpatient service).
2) Achilles tendon release: When the plaster fixation reaches more than 75 degrees of foot abduction, Achilles tendon release can be performed. Plaster fixation was performed for 3 weeks after operation. After 3 weeks, the plaster was removed and orthopedic shoes was replaced.
3) orthopedic shoes's treatment: After the operation, he wore Dennis Brown orthopedic shoes for further treatment, usually until he was 4 years old.
(2) French massage technique: Newborns should be treated with manual therapy immediately. During the operation, they should bend their knees 90 degrees, hold the heel with one hand and push the forefoot with the other hand to make the forefoot abduction and correct the forefoot adduction, then hold the heel for eversion, and finally hold the heel with the palm of their hand and stretch it back to correct the horseshoe, and do it several times a day until the deformity is corrected.
2. Surgical therapy
For children who missed the opportunity of non-surgical orthopedic surgery or did not wear orthopedic braces according to the doctor's advice after orthopedic surgery, corresponding symptomatic surgical treatment should be carried out according to their different situations.
(1) extensive soft tissue release: surgical methods include Turco, Mckay, Carroll, etc. The aim is to release the soft tissue of ankle contracture and restore the normal anatomical structure of tarsal bone. General principles for the treatment of clubfoot at any stage of extensive release include:
1) Loosen the tourniquet and stop bleeding by electrocoagulation;
2) When necessary, make the foot in plantar flexion position, and carefully suture subcutaneous tissue and skin to avoid excessive skin tension;
3) When the plaster is replaced for the first time 2 weeks after operation, it can be placed in a completely corrected position.
(2) Achilles tendon lengthening: For children (generally 2-3 years old) who have missed the achilles tendon loosening operation, they need to loosen the achilles tendon to lower the calcaneus, and then perform achilles tendon lengthening and Z-incision. Plaster fixation was performed for 6 weeks after operation.
(3) External displacement of tibialis anterior: It is suitable for children with early mild recurrence of horseshoe foot or residual adduction deformity of forefoot after treatment.
(4) External fixator: For older children with rigid clubfoot (generally over 5 years old), the foot bone has ossified, and the deformity cannot be corrected only by soft tissue. External fixator technology can be used, and the bracket should be adjusted regularly after operation. The appearance is basically satisfactory, but the ankle joint stiffness will still be retained.
(5) Orthopedic foot osteotomy: There are many surgical methods. Generally, children are over 5 years old. According to the deformity, different osteotomy combined with external fixator can be used to correct clubfoot deformity.
(6) Three-joint fusion: the indication is1children over 0 years old; Combined metatarsal adduction, hind foot varus and plantar flexion; You can consider this operation.
Surgical treatment should take into account the growth factors of limbs, and surgical correction can be carried out in stages without being too destructive.