Clubfoot Treatment Is a Success for On-the-Go Graham

Graham Watson is an energetic and fearless first grader who loves playing soccer, tag, hide-and-seek and his favorite video games. Graham Watson is an energetic and fearless first grader who loves playing soccer, tag, hide-and-seek and his favorite video games. He’s an adrenaline junkie, too.

He likes anything fast, tall and scary,” says his mother, Courtney. “There are zero limitations on what he can do.”

During her pregnancy with Graham and his twin brother, Tanner, Courtney had learned that Graham had clubfoot - a condition that causes the foot to be rotated inward with the bottom of the foot facing sideways or upward. In Graham’s case, both feet were affected - bilateral clubfoot.

She worried. Would Graham have the same quality of life as Tanner? Would he be able to do all the things his older brother Parker could do?

Clubfoot affects about one infant in every 1,000 births in the U.S., according to the American Academy of Orthopaedic Surgeons, and the cause is often unclear.

Before the twins were born, Courtney and husband Josh met with Dr. Matthew Ravish, a pediatric orthopaedist with Atrium Health Wake Forest Baptist Brenner Children’s Hospital and assistant professor, Wake Forest School of Medicine Department of Orthopaedic Surgery and Rehabilitation, about a treatment plan for Graham. Brenner Children’s Hospital has physicians on staff who are fellowship-trained in pediatric orthopaedics, with special expertise in treating conditions in children that range from routine to complex.

“That put our minds at ease because we learned exactly what to expect,” Courtney says.

The treatment Ravish outlined was the Ponseti method. The nonsurgical technique uses gentle stretching, casting and bracing over several years to rotate the foot into the correct position. Ravish, a regional leader in the Ponseti method, receives referrals from throughout the region for his expertise in the procedure. Wake Forest Baptist is one of the highest volume clubfoot centers in North Carolina. 

When Graham was 3 weeks old, he began weekly visits with Ravish for casts to stretch and manipulate both feet. After two months of casting, he had a minor procedure at Brenner Children’s Hospital to lengthen the Achilles tendon. The final part of the Ponseti treatment was bracing, which began at around 4 months old and continued for the next four years. Before Graham even started walking, the braces were worn only during sleep. 

“It was a little intimidating and seemed like it would take forever to complete the process,” Courtney says, “but it’s really just a fraction of time, compared to the lasting effects.”

Graham Watson as an infant.“The Ponseti method is used to treat more than 95% of children with clubfoot ,” says Ravish, whose expertise makes Brenner Children’s a leading destination for the treatment. Outcomes are very good - leading to a fully flexible, functional foot - when the protocol is closely followed.

“We tell families that the first two steps in the process – casting and the Achilles procedure - are on us, but the last step, and the hardest - four years of bracing - is mostly on them,” Ravish said. “Recurrence is extremely high if the brace protocol is not followed, and it’s extremely low if the brace protocol is followed.

“It’s one of the more common congenital deformities that needs treatment in children, and treating it is a real strength of ours. We have a highly regarded program and a great support team, from nurse practitioners and cast technicians to athletic trainers and surgeons, when needed. We see patients from across the state and even from outside North Carolina.”

Ravish emphasizes to parents that their child will have few, if any, memories of the treatment process.

“Even though this seems like a significant deformity for their 4-week-old, their 4-year-old will be able to do everything their siblings are doing,” he says. “It will not limit them in any way.”

Among Graham’s few memories of the treatment, which he completed two years ago, most are only about his friend - Ravish.

“Dr. Ravish is super nice and he makes me laugh,” Graham says. “He always has me run all the way to the end of the hallway and back.”

Fun for the 6-year-old. And gratifying for his parents.

“We could never have imagined that things would turn out this well,” Courtney says. “Graham’s feet are perfectly straight, and he’s able to walk and run normally. Dr. Ravish did such a great job that my very active, on-the-go boy has since broken both arms in two years. We’ve seen Dr. Ravish to treat those, too – we wouldn’t trust anyone else.”