The prenatal counseling importance in congenital talipes equinovarus treatment

Congenital talipes equinovarus (clubfoot) is a relatively common congenital deformity, affecting about 1 to 3 per thousand live births, generally idiopathic but sometimes associating different conditions: chromosomal anomalies, neuromuscular or urological diseases. Nowadays, the diagnosis is made prenatally, by having a detailed fetal ultrasound scan. The standard care of this condition is a non-surgical treatment according to Ponseti method; it can be initiated soon after birth and consist in manipulation of the foot and application of plaster casts, once a week, for about 4 to 6 weeks, followed by Achilles tendon tenotomy and a final cast for 3 weeks; after that, the corrected position must be maintained by applying a brace (boots connected by a bar) the child must wear inconstantly during the day, but until 4-5 years of age. The major benefit of prenatal diagnose is related to the family counseling, as long as having a baby with this kind of structural malformation will generate a spectrum of emotions to the parents and relatives; having the opportunity to prenatally present the baby's condition to the parents and discuss a treatment which is highly effective and non-invasive is very important in terms of increasing parental confidence and gaining their cooperation; those aspects are important both for psychologically reasons, preparing the family to have a baby with a visible structural malformation, but also to accept an excellent but demanding treatment, and obtaining active involvement of the family in the children's treatment: getting them prepared for seeing the baby’s leg/legs in plaster casts, several visits to the clinic, limitation in the family life during the treatment and more important transferring them the responsibility of the home treatment (the compliance to the bracing protocol in order to maintain the correction). © 2015 The Authors. Published by Elsevier Ltd. Peer-review under responsibility of Academic World Research and Education Center.