Club Foot

Thirteen-year-old Anna Litttleton loves to run – and she’s good at it. So good, in fact, that coaches at Mountain Brook High School recruited her to the varsity cross-country team last season while she was still a 7th grader. The team went on to win the 6A state title and Anna achieved All-State (Top 15) status.

But when Anna was born, all her parents were hoping for was that one day she would be able to walk properly and have normal looking feet.

“Our obstetrician recognized at birth that Anna might have bilateral clubfoot,” says Amy Littleton. “Anna’s pediatrician, Lillian Israel, confirmed the diagnosis and less than a day later, Dr. Scott Doyle (whom we already knew through family connections) was examining Anna in the hospital room.”

Clubfoot, or talipes equinovarus, is a treatable birth defect that affects approximately 150,000-200,000 children each year. It can be corrected by casting and/or surgery.

Dr. Doyle, an orthopedic surgeon at Children’s of Alabama, recommended the Ponseti Method, a non-surgical treatment developed in the 1940s by Dr. Ignacio Ponseti. It involves correcting clubfoot in infancy through gentle manipulation of the feet followed by the application of plaster casts – thereby eliminating the scarring, stiffness and muscle weakness often suffered in adulthood by patients whose clubfoot had been surgically treated.

Although Dr. Ponseti had been using the method for years at the University of Iowa, it was only beginning to gain acceptance in the medical community at about the time Anna was born.

Amy and her husband, Michael, felt comfortable with Dr. Doyle’s recommendation. “We both have medical backgrounds – Michael is a general surgeon and I formerly was a physical therapist at UAB – so we understood the terminology that Scott used, as well as the theory behind the method,” she says.

“We were very familiar with Children’s, and we never thought once about getting a second opinion,” she adds. “Scott put on Anna’s first set of casts the same day – right in the hospital room.”

Anna was in casts for about seven weeks, followed by braces 24 hours a day for several months, then braces at night only until she was about a year old. During that time, she visited orthopedic clinics at Children’s main campus and also at Children’s South.

“At each clinic visit, we were treated with such compassion and patience,” Amy recalls. “I remember the first time that Anna’s casts were to be removed. She was only a week old, and when the cast saw was turned on, Anna, my 3-year-old daughter, Katie, and I all began to cry! I was nervous that Anna, because she was so little, was in danger of being cut while the casts were being sawed. But the technician was very reassuring, explaining how the cast saw works and then slowly cutting the cast away.”

Anna took her first steps at age 10 months – and she has not slowed down since.

“We first noticed Anna's love of running when she and her classmates would run a mile in PE at school for the Presidential Fitness testing,” says Amy. “Then in the summers following the 4th, 5th and 6th grades, she participated in a Magic City Track Club running program directed by one of her current coaches, Randy Stephens. Through that program, she learned warm-up, stretch and conditioning drills and was introduced to long-distance running.

“We knew as Anna talked about the miles they ran those summers that she really enjoyed running. But it was not until her first meet as a member of the Mountain Brook Junior High cross-country team that we realized what a gift for running she has. Michael and I were out on the trail and were shocked to see her coming through with the lead runners. We turned to each other and said, ‘She really is good!’ That whole season was full of surprises as she continued to improve and was eventually pulled up to the varsity team.”

Anna describes herself as very competitive, and she says she enjoys the team aspect of the sport. “But overall, I just love running because of how fun it is,” she says. “My parents and teachers used to tell me that I was fast and should run, but I am sort of surprised by my success. I am blessed to have such great doctors, parents and coaches. I would not be where I am today if it were not for them.”

Dr. Doyle says he and his associates in Orthopedic Surgery at Children’s (Joseph Khoury, MD; Michael Conklin, MD; and Shawn Gilbert, MD) see about 30-40 new clubfoot patients each year – and their goal with each baby is to achieve the kind of results Anna has experienced.

“I was not completely surprised when I learned last December that she is a cross country superstar,” he says. “While some of our patients do require surgery or recasting, Anna represents the best the Ponseti Method can achieve. She fulfills what we would hope for with all of our patients.”

Anna does not remember being treated for clubfoot, but she is well aware of the problems this condition presents to families in Third World countries, where it often goes untreated. Neglected clubfoot limits the prospects of those living in developing countries as they often are unable to walk without great pain and do not have many job opportunities or the ability to carry out many daily tasks.

So – along with her goals of reaching All-State in the Cross-Country Championship every year in middle school and high school and completing a RunDisney marathon – Anna says she wants to help people from throughout the world who have clubfoot.

She’ll take a step in that direction on June 7 when she joins about 250 former Children's of Alabama clubfoot patients and their family members at a Birmingham Baron's baseball game, where she is slated to throw out the first pitch. The patient/family event was scheduled in conjunction with World Clubfoot Day (June 3) to help increase awareness of this condition and how it can be successfully treated.

Amy and Michael will be watching proudly, just as they do at her cross-country meets. “When she is running, I forget she is only 13,” Amy says. “But then later in the car, when she belts out the tune ‘Let it Go’ from the movie Frozen, I remember she is still so young. We are looking forward to see where running takes her.”