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Physiotherapy Clubfoot Program

The treatment of clubfoot has evolved to a process that requires minimal to no surgical intervention. There are three main stages of treatment:

  1. Serial manipulation and casting
  2. Achilles tenotomy
  3. Maintenance

Serial manipulation and casting

The structures of the foot and ankle are stretched and gradually realigned using gentle manipulations and application of a cast to maintain the degree of correction and re-mould the soft tissues. The cast must extend from the toes to the upper thigh in order to achieve proper alignment of the ankle/foot complex.

Casts are changed weekly, with gradual correction each week.

Achilles tenotomy

The Achilles tendon is particularly stiff in congenital clubfoot, and often range of motion of the ankle is resistant to casting.

The majority of patients require a minor surgical release of the achilles tendon, which can be performed on an outpatient basis, under local anesthetic. The process involves a minor incision, and is fully healed in three weeks.


To prevent relapses after the last cast is removed, a brace must be worn full time for three months and then at night for two to four years.

The brace consists of open-toed shoes attached at the base by a shoulder-width bar to keep the affected foot turned out/externally rotated. This brace allows for hip and knee motion, and children maintain and achieve age appropriate motor patterns while wearing the device. Once the child is wearing the brace at night time only, no other special footwear or equipment is required during awake/day time. For location and more, see Clubfoot Clinic.

For more about treatment with a boots and bar orthosis, visit AboutKidsHealth.ca.