The topic of your MSc thesis on SOTE-ETK was the treatment of babies born with clubfoot. Can you please share the focus and conlusions of your research?
The focus was the scientific studies from the last 10-15 years that compared the results of conservative vs. surgical treatments and the comparison of various conservative treatment types. (Zapata and Co, 2018; Sala and Co, 2013; Karol and Co, 2016). The professionals performing the examinations prefer the conservative treatments vs. the surgical ones. (Zapata and Co, 2018). The comparison between the French functional method, which involves no surgery and the Ponseti method, which has minimal surgical intervention show that the children treated with the Ponseti method come closer to the normal physiological range of joint movement, while the children treated with the French functional therapy surpass those treated with the Ponseti method when it comes to the quality and development of their gross
motor skills and gross motor function (GMS and GMF) (Karol and Co, 2016). The most important note for us (physiotherapists) is that the Ponseti method is an excellent way to correct the deformed structure of the foot, but it doesn’t help sufficiently with the body’s complete gross motor functions. The studies do not focus on measuring the development of the gross motor functions, as a result it is not apparent for
them that the distortion of the kinetic system of the lower limbs (the coherent functional connection of the joints of the lower limbs) exists already in the beginning of the development of the motor skill patterns (onthogenesis of the motorium). Meaning out of an incorrect set of motor skills only incorrect motion patterns can result. (crawling, sitting – W shaped sitting) The French treatment identifies the problem of the difference in quality of the motor skills of children with clubfoot and those treated with the French method. (Zapata, Karol and Co, 2018; Karol and Co, 2016) The studies highlight this problem, but they do not provide any recommendations for resolving this.

How does the treatment change with the growth of the baby (when can it actively participate in the treatment)?
In my opinion if the clubfoot is not accompanied by any other syndrome there is no need for any other therapy. The natural development of age-appropriate motion patterns (in some cases exercises supported by special tools) are the therapy within themselves. In case of need however as the child gets older, regular contact with the physiotherapist can ensure prevention and correction of any deviation from the
normal by learning specific exercises.

When is a clubfoot patient considered ‘healed’?
From the perspective of the physiotherapist: In case of proper correction of the foot, with all the systems serving the optimal functioning of the motorium, (by the ages 6-7) the foot as an anatomic unit completes its physiological development and there should not be any significant deterioration of its condition.
Doctor colleagues also consider it important to mention that during treatment they aim to reach healthy characteristics, but it must be made clear that this doesn’t mean a 100% physiological state. As a parent one has to carefully monitor the child’s foot. In my experience by the time the check ups get less frequent, parents of clubfoot children become sufficiently trained and will know what is needed to be able to evaluate the current status of the foot. What this means is that if you see any deviation, make sure you get in touch with your therapist or doctor, what it definitely doesn’t mean though is that you mustn’t make your own conclusion on the change.

What makes the Dévény method stand out when treating clubfoot patients?
„Look at what everyone is looking at, and see what no one else has seen.” Thomas W. Myers
This quote represents the secret to the Ponseti method’s and the Dévény technique’s success and unique effectiveness. To understand determining connections we need to look at the human body at its complexity, while putting its functionality in the forefront. These connections remain hidden for therapies that only focus on a specific part of the body. This nature of experiencing helps recognise and observe the
functional pathomechanism, which forms the backbone of my thesis too.

When should the Dévény treatment be started in case of clubfoot?
The DSGM therapy should ideally start at the same time when the patient starts wearing the boots and bar (in certain cases it is possible to start during the casting period, while this is really good, it is not a problem if it is not happening). If we consider the phases of the Ponseti-treatment, the 23 hour bracing period starts at the time when voluntary movements of the gross motor skills start to appear. (3-3.5 months – this is a very sensitive period for the development of the central nervous system)

Can you please share a few things about you and your professional background?
My name is Orsolya Türei, licensed physiotherapist (MSc in physiotherapy) and DSGM specialized physiotherapist. I have been working at the Heim Pál Children’s Hospital for nearly 20 years now. My clinical speciality is pediatric orthopedia and as a result of my specialized qualification pediatric neurology.

How did you become aware of the Dévény method and the Ponseti treatment?
Clubfoot (pes equinovarus congenitus) is one of the most common orthopedic birth defect, I encountered it in our hospital where the doctors apply the unique Ponseti method to treat it.

The correctional system of Ignatio Ponseti is a primarily conservative way of treatment. It’s success comes from the fact that the treatment plan is relying on the biomechanical knowledge of the foot.
This functionality motivated me to dive deeper and learn more about it. Apart from this by 2010 I learned a unique physiotherapy method: Dévény Special Manual Technique & Gymnastics Method (DSGM), the unique outlook of it further allowed me to develop my systemic approach to clubfoot treatment. Our Hospital is a Ponseti treatment centre, the number of clubfoot cases I encountered and the special approach of the Dévény method on interpreting the pathology of the human body, together served as a foundation for my MSc diploma thesis. It is titled THE ROLE AND RELEVANCE OF THE DÉVÉNY METHOD WHILE CORRECTING CONGENITAL CLUBFOOT WITH THE PONSETI TREATMENT, after the evaluation I have received an excellent grade on it in 2020. I hereby would like to thank all the families for their support who answered the questionnaire I posted earlier.

Could you please explain in plain words the different between SMT and STG?
This original therapeutical method has been developed by physiotherapist and rhythmic gymnastics coach Anna Dévény (1935-2017) since 1976, based on the experiences of her two professions. Dévény Special Manual Technique & Gymnastics Method (abbreviated as DSGM) is a new therapeutic method in motion rehabilitation proven by several decades of practical experience. It builds on a new approach, applies radically new technical elements and implementation, therefore it opens new, previously unknown opportunities in medication.
DSGM covers two main fields of application: DSGM I.-, and DSGM II.
(source of translation: https://dsgm.eu/en/deveny-method/)

Can you please share a few things about you and your professional background? Why did you start concentrating on medical pedicure?

From the beginning my main focus was medical pedicure. Making a healthy foot look beatiful and looked after is the job of a podiatrist. Treating or preventing any of the following is what a medical podiatrist does: Corn, calluses, ingrown toenails, inflammation, infection. I like my job, I do it with humility, passion and the necessary qualifications. The age range of my customers starts from newborn babies and my oldest customer is 89 years old.

Compared to the traditional beauty pedicure, how is medical pedicure different and in what cases is it required?
A medical podiatrist won’t just simply make the foot prettier, they also make the foot healthier. They are trained to notice potential concerns and prevent them causing more serious issues. They are capable of resolving problems like: ingrown toenails, treating the skin of the foot and the sole, for example warts and the foot of people with diabetes. It is mandatory to get orthopaedic and anatomic training as part of the qualification. Today there are various professional products and tools that help perform this type of treatment.

Which cases can be treated at home? When parents come to you regarding their babies, what are the most common issues? Can a baby get a pedicure at all?
Ingrown toenails are the most common problems for babies and the resulting mild inflammation, so these are the cases I encounter most often too. Since most of the parents pay very close attention to even the smallest sign of concern when it comes to their babies there are very few cases when I see a severe case of inflammation (in these cases I anyhow recommend going to a specialist doctor). When treating babies I always adapt to the situation, for example while the mother was breast-feeding her baby I was treating its nails.

How can we as parents decide at which stage we have to go to a specialist doctor?
Sticking with the previous example of ingrown toenails, in general I recommend visiting a doctor if the inflammation is already wide-spread (ie: complete around the whole nail). In such cases special treatment and anti-inflammatory medicine is required, sometimes even antibiotics might be necessary.

Let’s start with the basics: how do the nails of babies grow, how do they change as children get older?
They have chubby feet and their toes are very close to each other, no gap between them. Their small toenails are sharp and wide, often curved upwards. This means their nails don’t grow towards the distal phalanx, but deviates by various degrees from the horizontal line. This applies to babies in general, it is not clubfoot specific. This can be caused by wearing unsuitable shoes or in case of newborns even stockings, socks or rompers that are too tight, short or just have a bad cutting… Incorrectly cutting the nails can also result in this. In case of clubfoot babies the casting period can also affect the condition of the nails. As children grow the shape of their nails change too. There is no cause for concern if they have tiny, short and shapeless nails when they are still small babies, even if these are difficult to cut properly. As the years go by these usually turn out just fine in the end. (in case they don’t, these can be treated by medical podiatrist, but those treatments are not part of this blog post)

How do we properly cut babies nails? How can we prevent ingrown toenails and the resulting inflammation? What type of socks do you recommend, what points should we consider?
Okay, let’s start with the first part of the question: you should use blunt-tipped “baby scissors” to shorten the toenails, alternatively nail-clippers are also fine. Regarding the length of the nails, with a little practice you will get used to it and feel what’s right. If you cut it too short it will cause pain, if it is kept too long it can get stuck in the socks. Since their nails are very soft and weak, they can get stuck very easily and it could end up ripping them off. This is of course painful and can result in inflammation. Make sure you leave a little bit of free edge. It’s very-very important that you cut the nails along the full curve. You mustn’t have any hangnails left on the sides. In case you don’t manage to do this properly at home or you end up with inflammation of the nail bed you should seek out the help of a professional. They will be able to cut the nails properly and can even show you how to do it the right way at home next time. This professional can be a medical podiatrist, your paediatrician or nurse, it’s a matter of who you trust more.

Since clubfoot babies spend around 23 hours a day in braces during the early period, their feet are in a fixed position that’s why it is very important to have socks of the right size and right material. The socks and tights should have a high cotton content and always make sure to choose the right size, since if the socks are too tight they can squeeze their feet too strong. On the other hand if the socks are too loose, you’ll get crumples while in the boots and that can put pressure on their skin. It is recommended to wear high stem socks (tights when it’s colder), so the synthetic part of the boots don’t get in touch with the baby’s skin.

As a result of the casting the nails of clubfoot babies can get damaged or even deformed in some cases. As parents what should we do if we notice any mild inflammation when the new plaster cast is applied?
If the doctor who applies the cast doesn’t notice the problem, we should definitely highlight it ourselves, since a visibly small inflammation can get severely infected during the next 1 week period. So the best option is to ask the doctor for his opinion right away.

Let’s talk a bit about foot care in general, this is extremely important for clubfoot babies because as a result of the casting and later the 23 hours bracing period skin problems might occur.
Right after birth babies begin their “work-out” so by the time they are 10-15 months old they can take their first steps. This cardio exercise makes their muscles stronger. Their hands and feet are constantly moving, except when they are asleep. Their little plump toes are so close to each other that they can get sweaty very easily, especially as parents tend to dress them up too warm (irrespective of the time of season). For clubfoot babies then you have the plaster cast and the boots later on top of all this. Let’s not forget about that fact that babies tend to “grip” with their toes up until about 12 months, even if not all the time. This is why foot hygiene is so important. Use bath products recommended by the paediatrician (or nurse) for and after bathing to take care of their feet.

You should always treat them to a little tender foot massage, carefully stroking them. Stimulating the foot muscles and massaging the little toes one-by-one is not only a nice treat for them, but it also helps make the foot stronger and ensures the right development of the foot arch. Your baby will definitely appreciate the feeling. It’s very important to ensure that the foot is completely dry (no moisture, lotion, oil) before putting on their socks (and boots). I don’t recommend using baby powder since it can cause irritation as it clumps up when it gets moist.

The casting period can have an effect on the sensitive baby skin. It’s a good idea to wash the baby’s leg prior to the casting with lukewarm water using bath cream. Pay special attention to the part between the toes, make sure it’s completely dry. If there is no visible skin problem, use skin cream and apply it in a thin layer several times (if time allows), rather than once but using too much. The skin should be dry (no oil or moisture residue) when the plaster cast is applied. If you notice any symptoms of eczema, fungal infection or skin rash, ask your doctor. It is very important that the cast should not be applied if there is any skin problem, although making this decision is the doctor’s responsibility.