Q: Dr. Eppley, I was born with club feet. I had Achilles release surgery as a baby. I am now 25 and have been considering calf augmentation for a number of years.
A: Thank you for your iuquiry. It is quite common as you know that the associated calf on the clubfoot will have a smaller and more atrophic leg between the knee and ankle. While calf augmentation with an implant is a reasonable and standard approach for this problem, the unique issue with the ‘clubfoot calf’ is how tight the skin is around the calf area. This limits the size of the calf implant that can be placed and how much change (calf size increase) can actually be obtained. You can see that placing implants in a cosmetic calf concern where the skin and underlying soft tissues are soft and supple is quite different from that of a congenital calf deformity where the skin is more tight and less prone to stretch. It would be helpful to see pictures of your calfs and to know the actual circumferential measurement around the mid-portion of your calfs.
Dr. Barry Eppley
Q: I was born with a club foot. I had my first surgery when I was a few months old. I would love to have matching legs. Does insurance cover this since it is a bitth defect?
A: One of the aesthetic sequelae of a club foot deformity, which is one of the most common birth defects, is that of calf asymmetry. Due to the foot deformity, the calf muscle of the involved leg does not develop to the size of that of the normal opposite leg. This results in one calf being smaller than the other which causes an aesthetic imbalance of the lower legs. This can be improved with a calf implant which is placed from an incision on the backside of the knee. While the small calf size can be improved, it rarely can become exactly as big as the opposite side as the calf skin is very tight and will only expand so far. This is done as simple outpatient procedure that takes about an hour to perform. Calf implant surgery for club foot is not covered by insurance even though it is being done to correct a congenital deformity. This is because the implant is not improving the function of the leg (medically necessary) but is being done to improve how it looks. (cosmetic) The lower leg will not work any better as a result of the implant but it will look more symmetric to the opposite side.
Dr. Barry Eppley