Clubfoot & Neuromuscular Related Deformity Correction

Clubfoot & Neuromuscular Related Deformity Correction



Foot deformities are a wide variety of conditions that affect the bones and tendons in the feet. The conditions can be congenital, result from imbalance of muscle force due to neuromuscular disease, or just develop as children grow. The deformity may not be painful during infancy. However, if severe foot deformity left untreated, the foot will remain deformed, and he or she will not be able to walk normally. With proper treatment, however, the majority of children are able to enjoy a wide range of physical activities with little trace of the deformity.


Why do you choose our hospital?    

The goal of our pediatric orthopedic team is to provide the most technologically advanced treatments to those who suffer from congenital, developmental, and post-traumatic orthopedic conditions. We have experienced nation-class surgeons who perform high volume of surgeries every year. Physicians and specialist in Taiwan frequently refer their patients to our institute particularly when the diagnosis is unclear, the procedure is complicated, or even the most common conditions warrant the best of care. We have built a coordination team formed by pediatric orthopedic surgeons, pediatrician, neonatologist, pediatric nurse, psychologist and physical medicine and rehabilitation specialists. Our patient care coordination team will provide personalized and thorough approach to achieve the right diagnosis and the right access to care. We focus not only on the disease but also on the patient. Patients and their families can trust they will receive the world-class comprehensive medical care in our institute.


What conditions do we treat?




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 one infant in every 1,000 live births will have clubfoot, making it one of the more common congenital (present at birth) foot deformities. Children typically do not experience pain or discomfort as a result of calcaneovalgus foot (an outward heel when look from behind).

Clubfoot in an otherwise healthy child can be effectively treated with minimally invasive procedures such as The Ponseti technique. This technique uses a series of very specifically molded casts to guide a child’s clubfoot into the proper position. The duration of serial casting change is typically 6-8 weeks, and then a brace would replace the cast for maintenance for several years. This method is effective and has dramatically reduced the operation rate in clubfoot patients; however, family support and patient compliance play a key role for best outcome, especially in the maintenance phase of treatment.   

Surgical options

Due to the effectiveness of the Ponseti method, major procedures for clubfoot are now almost never performed. Most of refractory cases required surgeries are neuromuscular-related, syndromic (accompanied with other disease that affect musculoskeletal growth) or delayed treatment in infancy.

The surgery comprises releasing the contracted tendon and fascia, tendon transfer to decrease deforming force, and osteotomy for deformity correction. Currently, these procedures are performed on less than 20% of children treated for clubfeet.


Flatfoot, Calcaneovalgus foot


Flat foot also known as fallen arches and pes planus is a condition where the arch of a foot either does not develop or collapses. Unlike a normal foot, the sole of a flat foot lacks a medial concave curve which results in the foot having complete or nearly complete contact with the ground when standing. The condition normally does not cause pain or discomfort but in some cases children may experience pain in the affected foot, ankle, and leg. Calcaneovalgus foot is a flexible flat foot deformity that causes the heel to bend outward of the ankle. Many cases of flatfoot and calcaneovalgus foot will resolve over time with stretching exercise or no intervention. Surgery is not recommended when the deformity dose not cause pain or affect a child’s ability to walk or participate in other activities.


・Surgical options

In severe cases, the deformities can cause pain and discomfort despite conservative management, such as an arch support or foot exercises. Surgical intervention is reserved for symptomatic deformities with poor response to conservative treatment, or patients with rigid deformity, which is difficult to correct by close method. In mild case, a minimal invasive procedure called arthroereisis can be considered. A mini spacer is temporarily implanted to the subtalar space to create the arch and correct calcaneovalgus. In moderate to severe cases, patient may need contracted tendon and fascia release, tendon transfer to decrease deforming force, and osteotomy for deformity correction.


High arch, Cavovarus foot


High arch or cavus foot is a condition where a foot’s arch is raised more than normal. The high arch causes pain and instability as a result of excessive weight falling on the ball and heel of the foot when walking or standing. High arch sometimes occurs as an inherited abnormality but typically occurs in children with neurological disorders or conditions such as cerebral palsy, spina bifida, and muscular dystrophy. Symptoms of a cavus foot include pain in the foot while walking, standing or running, inward tilted heel that causes instability of the foot and ankle sprains, callus formation on the ball and at the outer edges of the foot, toes that are bent (hammertoes) or clenched like a fist (claw toes), difficulty wearing shoes and/or shortened foot length. A high arch that is flexible can simply be treated by shoe modifications such as an arch insert or support insole to relieve pain while walking


・Surgical options

Surgical intervention is reserved for symptomatic deformities with poor response to conservative treatment, or patients with rigid deformity, which is difficult to correct by close method. The procedures typically include contracted tendon and fascia release, tendon transfer to decrease deforming force, and osteotomy for deformity correction.


Congenital vertical talus


Congenital vertical talus (CVT) is a fixed flat foot deformity that causes the sole of a child’s foot to appear to have a convex curve or rocker-bottom appearance. This occurs as a result of the talus and navicular bones being abnormally positioned. Congenital vertical talus is usually present at birth. The sole of the foot appears convex, the arch of the foot is reversed, and there is a crease on the upper portion of the foot. A callous may form on the sole of the foot at the place where the protruding talus bone touches the ground. If left untreated, it can cause pain in the foot which makes wearing shoes difficult and the child may begin to walk with a “peg leg gait”.


・Surgical options

It is important to diagnose and begin treatment for congenital vertical talus as early as possible to achieve better results. Casting to manipulate and stretch the foot is the first step in treatment. To complete correction of the deformity, surgery is performed to move the dislocated bones of the foot into proper position and locate the joint between the talus and navicular bones. A tendon release may also be performed if the Achilles tendon has become contracted. Older children may require more complex procedures such as fusion of the talus to the heel bone.


Tarsal coalition


The foot has group of bones located in the mid and hind foot that comprise the ankle and heel. A tarsal coalition is a developmental condition where two or more of a foot’s tarsal bones fuse together. Tarsal coalitions can occur across the joint between talus and calcaneus (talocalcaneal coalition) or between the calcaneus and navicular bones (calcaneonavicular coalition). Children typically do not develop symptoms until age 8 to 16 years. While symptoms vary, the most common are pain on the top of the foot, flatfoot, frequently muscle spasms and stiffness in the affected foot

  • Surgical options

Stretching exercises or bracing can be utilized as first line therapy. For patients with persistent symptoms despite nonsurgical treatment, resect the tarsal coalition and interpose the surface with autogenous fat tissue or artificial material to prevent recurrence can be considered.


Treatment timeframe

Consultation (Online available)

Pre-treatment planning

Explain treatment option, pros and cons, benefits and risks of treatment

Estimate cost

Informed consent



Physical Therapy and rehabilitation program

Follow-up visit


Potential complication

Treatment for foot deformities is usually challenging and requires longer treatment duration and follow-up compared to general orthopedic surgery. For these reasons, we are very conservative regarding many aspects of surgical option. The first priority of our care is patient safety and preventing complications. Potential complications are listed below, most of which are reversible and will not cause permanent sequela.

Wound infection requiring antibiotic treatment or debridement

Intraoperative bleeding requiring transfusion

Nerve injury during correction

Nonunion after osteotomy


Estimated Cost

For estimated medical costs, please contact International Medical Services Center.


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