Explain a clubfoot diagnosis and the Ponseti method to a parent — OSCE

OSCE communication and shared-decision station: explaining a new diagnosis of the idiopathic clubfoot to the parent of a one-week-old boy, outlining the Ponseti method from the serial casting through the percutaneous Achilles tenotomy to the foot-abduction brace in plain language, addressing the fear and the long-term commitment of the bracing without overwhelming, and securing the family-centred agreement to the protocol.

osce communication and shared decision-making4 min readVerification in progress

Prompt

The mother of a one-week-old boy, found on the routine baby check to have a right clubfoot, has been referred to the paediatric orthopaedic clinic. She is frightened that her son will never walk normally, anxious about the operation she has heard about, and overwhelmed by the prospect of a brace for four to five years. She asks you, the general paediatrician, to explain the diagnosis and the treatment in plain language before the orthopaedic appointment. Counsel her.

Communication framework

Establish what the mother already understands and fears. Ask her to tell you, in her own words, what the midwife or the doctor told her about the foot, and what she is most worried about. The fear that her son will never walk, the anxiety about the operation, and the overwhelm of the brace for years are the three emotions you will spend the most time addressing, and you address them with the plain language, the realistic prognosis, and the evidence that the Ponseti method works. Do not launch into the plan before you have heard her. [1][5]

Explain the diagnosis in plain language. Tell her that her son has a clubfoot, a condition where the foot is turned inward and downward at birth, and that it is structural, not caused by anything she did in the pregnancy. About one in a thousand babies are born with a clubfoot, and boys are affected twice as often as girls. Reassure her that the foot is normal in its bones and its structure, and that the deformity is in the soft tissues — the ligaments and the tendons — that hold the foot in the wrong position. The treatment will move the foot to the correct position and hold it there. [5][2]

Explain the Ponseti method in plain language. Tell her that the treatment is called the Ponseti method, after the doctor who developed it, and that it is the global gold standard, used in over one hundred countries. The treatment has three parts. The first part is the serial casting: five to seven weekly long-leg casts, from the toes to the top of the thigh, that gently move the foot to the correct position over five to seven weeks. The second part is a small procedure, called a percutaneous Achilles tenotomy, to release the tight tendon at the back of the ankle, performed under the local anaesthetic in most cases, with a three-week cast afterwards. The third part, and the most important, is the foot-abduction brace — a pair of shoes connected by a bar, holding the feet in the turned-out position — worn twenty-three hours a day for the first three months, then nightly to the age of four to five years. [1][3]

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References4Show ledger

[1]Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am, 1992.PMID 1548277
[2]Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am, 1995.PMID 7593056
[3]Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics, 2004.PMID 14754952
[5]Chu A, Lehman WB. Treatment of Idiopathic Clubfoot in the Ponseti Era and Beyond. Foot Ankle Clin, 2015.PMID 26589078