- Stretching Exercises
Mild and moderate forms (~85% of patients) are initially treated by stretching exercises administered by the child’s parents. Despite its common practice, the effectiveness of stretching is questionable with many parents unable to implement this consistent routine into their days as part of treatment.
- Serial Casting
If the deformity is not resolved by 2 to 4 months, serial casting is recommended with long leg casts being applied every two weeks for a period of 6 to 12 weeks. Additionally, it is important to note, that the physician must take into consideration that casting is most effective prior, within the first 6 months of the child’s life and ineffective after 2 to 3 years. Severe and rigid cases of MTA (~15%) are prescribed serial casting in the first weeks of life. These patients may require night splinting to maintain correction after the casting is complete.
Currently, serial casting is considered to be the most commonly suggested treatment of MTA, but has distinct complications and disadvantages such as:
- Defective Casting: Improper casting technique can lead to crowding of toes, pressure sores, dangerous circulatory problem and other foot deformities.
- Hygienic Concerns: Maintaining a child’s hygiene with serial casting is challenging as it is to be kept dry. Skin irritation may occur, caused by urine and other foreign debris that make their way through the cast.
- Infant Stress: The cast its self is uncomfortable to wear and at its removal. A child often cries and screams during removal, heightening their stress to lead to possible psychological problems.
- Parental Stress: The experience of serial casting on children often causes stress for parents too, due to the unfamiliarity an uncertainty of the treatment outcome and possible complications.
- Under Treatment: Many clinicians believe that serial casting, which was developed for “Clubfoot”, is too harsh of a treatment for MTA and therefore choose a compromising attitude hoping nature and time will alleviate the deformity.
Failure of conservative treatment options in children older than 2 years of age may indicate surgery as an option for treatment.