Clubfoot is a congenital condition (which means it is present at birth) in which one or both feet turn inward and downward or up and out at the ankle.
The affected foot looks very similar to a golf club. It is a fairly common condition, affecting approximately one in every 1,000 live births. Medically clubfoot (also known as club foot) is referred to as congenital talipes equinovarus or CTEV.
Clubfoot can be mild or severe, and tends to affect males twice as much as females. Unfortunately, the cause of clubfoot is still unknown, but many experts believe it is genetic.
According to the American Academy of Orthopaedic Surgeons, if you, your spouse, or your other children have clubfoot, your future children are twice as likely to also have it. Half of all cases of clubfoot affect both feet.
If the condition is not treated during infancy, or before the child begins walking, risks may include:
- Smaller calf muscle of affected foot
- Walk on the outside or top of the foot
- Inability to walk normally
- Inability to move ankle/foot up and down
- May be related to another birth defect
- Additional problems involving muscles, tendons, ligaments, and joints in ankle and foot
- Increased risk of arthritis
- Development of calluses
What are the Symptoms of Clubfoot?
Clubfoot is not painful. The only symptom of clubfoot is the appearance of the foot. Most commonly it is seen bending in and down at the ankle. The affected foot, calf, and leg are smaller and shorter than those of the other foot.
When clubfoot is present in both feet, the soles of the feet touch. Clubfoot is not hard to spot and is rarely misdiagnosed. In fact, ultrasounds can sometimes detect clubfoot before birth. It is believed to be a structural defect caused by pressure exerted on the fetus by the uterus.
This is a rare occurrence, and unfortunately there are no treatment options available for a baby in the womb. However, detecting clubfoot before birth gives the parents a chance to contact the appropriate specialists, such as a podiatrist, orthotist, genetic counselor, or orthopedic surgeon.
When is Clubfoot Treated?
Clubfoot can be treated upon diagnosis at the time of birth. When a doctor recognizes the defect, he or she may order an x-ray. The earlier treatment begins, the better the chance of preventing the deformity from getting worse.
Your doctor will discuss the best time to begin treatment with you. Keep in mind that most doctors will want to begin treatment soon after birth, while the baby’s joints and bones are still flexible.
How is Clubfoot Treated?
In every case, the parent’s participation is vital to the success of treatment. Your doctor’s primary concerns are improving the function of the foot and restoring the foot and ankle to a natural appearance.
This should be done before the child learns to walk. If your case is mild, your doctor will show you how to manipulate your child’s foot regularly each day. This will allow the bones and ligaments to develop properly and it will help the foot settle into a normal position. Common ways of treating more severe cases of clubfoot include:
The Ponseti Method: This method consists of manipulating the foot into a normal position and casting it to help maintain the correct position. Every two days for the first two weeks, then at two-week intervals, your doctor will remove the cast, manipulate the foot closer to its normal position, and place a new cast or splint on the foot to hold it in its new position.
This process goes on for three to six months, after which stretching exercises, special shoes, or nighttime splinting may be necessary for up to two years. The long-term outlook for children treated in this manner is good. (See our article on physical therapy for further explanation of this treatment.)
Surgery: Surgery is usually reserved for severe cases. Most surgeons will wait until the baby is nine to twelve months old before attempting surgery, but some doctors perform surgical procedures on babies as young as three months. The purpose of the surgery is to lengthen the tendons to help the foot position itself correctly.
A brace is usually worn for up to a year after the surgery in order to prevent the problem from recurring. Unfortunately, the child will most likely experience stiffness in the affected foot as he or she gets older.
Failure to treat your child’s foot will result in severe disability and discomfort by their teenage years. Your child may be required to wear leg braces or other devices for the rest of his or her life. Plus, the calf muscles in the affected leg will never develop due to the inactivity of the foot.
What Are The Complications of Clubfoot?
If clubfoot is not treated at the time of birth, complications will arise when your child begins to walk and stand. These complications may include:
- Up to 1 ½ shoe sizes smaller than unaffected foot
- Child likely to have arthritis
- Unusual appearance of the foot
- Child may walk with an abnormal gait
- Calf muscles will not develop properly in the affected foot
- Large sores may appear on the feet, which can lead to an antalgic gait
- Calluses may develop
Can Clubfoot Be Prevented?
Because the cause of this condition is unknown, there is absolutely no way to prevent it. If you are pregnant, you should take care of your health in order to minimize the chances that your baby will be born with any other type of birth defect.
Questions to Ask Your Doctor
Here are some questions you may want to ask your doctor about clubfoot:
- Based on the severity of my child’s condition, what are the chances it will recur after treatment?
- What symptoms should I watch for that may indicate that the condition is recurring? (For example, casts may create problems with circulation, causing your baby’s skin to change color or temperature)
- What non-surgical treatment methods do you use other than the ones listed above?
- How long will healing take after treatment?