Over the course of his career, pediatric orthopedic surgeon William Schrader has treated hundreds of children with clubfoot.
So some might say it was ironic when his daughter, Laura Dickson, pregnant with his first grandchild, told him her baby, Isaiah, would be born with clubfoot.
His response: “no big deal.”
After hearing her father talk over the years about clubfoot, Laura said she pretty much diagnosed her baby’s clubfoot herself when she saw the unusual shape of his right foot during an ultrasound.
“I was seeing Dr. Melissa Mancuso because my pregnancy was considered high risk,” said Laura. “I asked the ultrasound technician if clubfoot is what I was seeing, but, of course, she couldn’t confirm it right there. I guess I just knew what to look for.”
Compared to many other birth defects, Laura knew from her father that treatment for clubfoot had become highly effective since Dr. Ignacio Ponseti, of the University of Iowa Hospitals and Clinics, developed a treatment focusing on stretching and casting to gradually correct the foot’s angle.
Dr. Schrader put Laura and her husband, Gary, in touch with Dr. Mark Adamczyk, who had taken over his leadership of Akron Children’s clubfoot clinic.
Dr. Adamczyk offered Laura additional reassurances and noted a few professional athletes who started life with clubfoot.
Clubfoot is a deformity in which an infant’s foot is turned inward, often so severely that the bottom of the foot faces sideways or even upward. Approximately 1 infant in every 1,000 will have clubfoot, making it one of the more common congenital birth defects.
While clubfoot isn’t painful during infancy, if left untreated, the child would not be able to walk normally.
Prior to the Ponseti Method, clubfoot was primarily treated with surgery.
But Dr. Ponseti’s method, which was introduced in the 1950s, gradually proved to be the superior approach and is now used worldwide.
“The majority of cases can be corrected in about 6 to 8 weeks with proper and gentle manipulations of the foot, followed by casting,” said Dr. Adamczyk.
The treatment is based on a sound understanding of the functional anatomy of the foot and of the biological response of muscles, ligaments and bone to corrective position changes gradually obtained by the manipulation and casting.
Two weeks after his birth, Isaiah came for his first of 5 weekly treatments with Dr. Adamczyk, who had the opportunity to train with Dr. Ponseti in Iowa just a few years before his death in 2009.
After manipulating Isaiah’s foot into a corrected position, Dr. Adamczyk and his team applied a leg-long plaster cast.
Each Monday, the cast would be removed, the foot manipulated and a new cast placed, guiding the foot a bit more each time.
After several weeks of manipulation and casting, many babies, including Isaiah, require a minor surgery to release tightness in the Achilles tendon.
After 5 weeks of casting, Isaiah will move onto wearing a brace called boots and bar (picture 2 baby shoes angled outward and attached to one another by a bar).
He will wear it 23 hours a day for 3 months. Then, he will wear it only during naps and bedtime until about age 4.
Dr. Adamczyk predicted Isaiah would have an excellent outcome.
“The Ponseti Method is everything you would want in a medical treatment,” said Dr. Adamczyk. “The results are spectacular. It’s inexpensive and it’s non-invasive.”
Laura plans to save Isaiah’s 5 plaster casts to one day show him how his clubfoot gradually took the shape of a “normal” foot.
“I will be glad when he is out of the cast, but, in the whole scheme of things, this is no big deal,” said Laura. “You have to be grateful for all the pediatric orthopedic surgeons, my dad included, who have perfected this method over the years. Thanks to them, Isaiah will walk, run and play like other kids.”