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Children's Health: Flat feet can be fixed without major surgery

Casting and bracing, along with minor operations, correct the severe foot deformity

Surgery is the standard option for children born with a rare foot deformity in which the sole doesn’t develop normally. But doctors have now invented a largely non-surgical approach to treating this flatfoot condition.

The birth defect — known as congenital vertical talus (CVT) or “rocker-bottom flat foot” — involves an abnormal positioning of bones in the feet. If left untreated, the condition causes the child to walk on the rear of the foot, with the toes pointed up.

To treat CVT, doctors at Washington University in St. Louis adopted principles pioneered in the 1950s for a more common foot deformity called clubfoot, which occurs in about one in 1,000 births. The technique involves a series of manipulations of the foot, and putting the foot in a series of casts to maintain the corrections. Minor surgery involving the tendons and joints of the feet is also performed, and the children wear a nighttime brace for several years to prevent recurrence.

“Much of the correction is achieved with casting alone,” says Dr. Matthew Dobbs, an associate professor of orthopedic surgery. “In the cases where we are not able to reach full correction with casting, we reach the rest of the correction with minimally invasive surgery.”

In a review of 11 children who had the procedure done on a total of 19 feet, Dobbs and his colleagues found that their techniques were successful in all cases. An average of five casts was required to correct the CVT, and no child needed extensive surgery. The children ranged in age from two months to 18 months.

Dobbs says this approach is catching the attention of pediatric orthopedic surgeons worldwide and he is now training other surgeons from North America and from around the world.

“If we can avoid operating on children’s feet, then they will have less scar tissue, with more mobility in the feet and less pain. The most important take-home message is that vertical talus can be treated without major surgery.”

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