What is Clubfoot?
Doctors are not sure what causes clubfoot. But they know it is likely to run in families and that it can happen when the mother smokes or takes drugs during pregnancy.
Most children who get treatment for the condition early have good long-term results. Treatment is usually done with casting followed by wearing a special brace (like the Denis Browne bar). It can take several stages to correct clubfoot.
Causes
Clubfoot (also called talipes equinovarus) is a birth defect in which one or both feet turn in and down. The bottom of the affected foot often faces sideways or up, instead of down. This condition is fairly common. It occurs in about 1 out of every 1,000 newborns. It affects boys twice as often as girls.
We don’t know what causes it, but we do know that genes play a role. Genes are the parts of cells that store instructions that tell the body how to grow and work. A problem with a gene that affects the way the foot and leg develop could lead to clubfoot. We also know that smoking or using drugs during pregnancy can raise the risk of the condition.
Sometimes, clubfoot happens as part of another condition present at birth, such as spina bifida or cerebral palsy (CP). In other cases, it is a standalone condition. Clubfoot treatment usually begins shortly after birth with a nonsurgical approach known as the Ponseti Method. The goal is to correct the foot, preventing it from ever returning to a clubfoot position. Treatment usually requires a combination of stretching, casting and bracing. This is repeated as the child grows. If treatment is delayed, the results are less successful and may require surgery later in life. In addition, untreated clubfoot may cause problems like sores and calluses on the legs or difficulty finding shoes that fit.
Symptoms
Clubfoot is a condition that affects the bones, muscles, and tendons in the feet. It’s usually present at birth, and it tends to be worse in boys than girls. Children with clubfoot can walk and play, but they may need help putting on shoes because their foot is smaller than the other. They may also need special braces.
Most cases of clubfoot are isolated (also called idiopathic) and happen in babies who have no other medical problems. This type of clubfoot is more common. But it can also happen together with other disorders or syndromes, such as arthrogryposis and spina bifida.
Your baby’s health care provider can identify the clubfoot by doing a physical exam of your child’s feet and taking an X-ray. An X-ray shows the bones of your child’s feet and can help confirm the diagnosis of clubfoot.
In most cases of clubfoot, your baby will need a surgery to release the tightened Achilles tendon. This is done with a thin scalpel under anesthesia. After the surgery, your baby will wear a special splint 23 hours a day and at night and during naps for several months. This treatment will be more successful if it begins early and is followed closely. Leaving clubfoot untreated or treating it late can lead to problems with walking and other health issues in your child’s body.
Diagnosis
A baby with clubfoot has an abnormal foot that points down and turns inward. It may look shorter and wider than a normal foot, with deep skin creases on the bottom of the feet and a tight heel cord (Achilles tendon). The calf muscles in the affected leg are smaller than usual.
Most cases of clubfoot are idiopathic, meaning they aren’t caused by any other condition. But it can also be a sign of a genetic disorder, or it can be a result of an injury in utero. It’s more common in boys than girls, and it can happen in one or both feet.
Your child’s doctor will diagnose clubfoot during a physical exam, possibly after examining your child’s x-rays. The doctor can feel how the bones are positioned in the foot and test the tightness of the tendons, which attach muscle to bone. The tightness of these tendons is how the doctor can tell whether a child has clubfoot.
Our doctors use the Ponseti method of treatment for most children with clubfoot. This involves manipulating and stretching the foot until it’s in a better position, then putting the foot into a cast. They change the cast every week for about 5 weeks. This process is most effective when it’s started soon after birth, and when the family can come to the doctor when needed.
Treatment
A number of treatment methods can help correct clubfoot. The most effective is called the Ponseti method. It involves manipulating and stretching your child’s foot while he or she is in a cast. This is done weekly for five to eight weeks. Some children will need a minor procedure to release the tight Achilles tendon (heel cord) at the back of their ankle, but this is not needed in most cases.
Your child’s doctor will also apply a long leg cast to hold the foot in its new position. This is a plaster cast that covers your child’s ankle to the knee. This type of cast is typically applied in four to five sessions. Afterward, your child will wear a foot-abduction brace. These braces have several different types, and they can be designed to accommodate the type of clubfoot your child has.
Some severe cases of clubfoot may require surgery to loosen the tendons or ligaments in the foot and ankle. This is most common in infants who have a neuromuscular condition like cerebral palsy or spina bifida, as these conditions often lead to clubfoot. In some cases, this includes a surgical procedure that transfers a tendon to the front of the foot (anterior tibial tendon transfer).
If your child’s clubfoot is not treated as early as possible, he or she will likely have a more severe deformity when it relapses and needs to be treated again. Children with clubfoot who are treated successfully as babies can expect to have good results and normal gait when they grow up.