Clubfoot

What is Clubfoot?

Clubfoot is a congenital condition (present at birth) that causes a baby’s foot to turn inward or downward. It can be mild or severe and occur in one or both feet. In babies who have clubfoot, the tendons that connect their leg muscles to their heel are too short. These tight tendons cause the foot to twist out of shape.

Clubfoot is one of the most common congenital birth defects. It occurs in about 1 in every 1,000 babies born in the U.S. and affects more boys than girls. In fact, boys are twice as likely to be born with clubfoot.

Usually, a baby born with a clubfoot is otherwise healthy. In a small percentage of births, it occurs as part of a more serious condition like spina bifida.

Clubfoot is not a painful condition for your baby. Most of the time, clubfoot can be corrected while your child is a still a baby. Treatment should begin a week or two after birth. Correction methods vary from manual foot manipulation over time to surgically fixing the foot.

There is a high success rate for treating clubfoot. After correction, your child should be able to participate in a variety of physical activities and lead a normal life. Children who do not get treatment for clubfoot will not be able to walk normally. Their foot or feet will remain deformed.

Symptoms of clubfoot

The symptoms of clubfoot vary but are easy to identify by a medical professional. Clubfoot could be more difficult to spot if you are a first-time parent and if the condition is not severe.

Symptoms include:

• A foot that turns inward and downward, with toes pointing toward the opposite foot.
• The foot, heel, and calf muscle on one side may be smaller than the other.
• In severe cases, the clubfoot may be twisted upside down.

What causes clubfoot?

Doctors are not sure what causes clubfoot. There is some evidence to suggest that there is a genetic link. This means it seems to run in families. Also, if you already have one child born with clubfoot, your next child has a greater risk of also having clubfoot.

There is also research to suggest clubfoot is more common in babies whose mothers smoked or used recreational drugs (street drugs) during pregnancy. This is especially true if there is already a family history of clubfoot. Plus, there could be a link between low amniotic fluid and clubfoot. Amniotic fluid is the liquid that surrounds a baby in the womb.

If you are pregnant and have a family history of clubfoot, you may want to meet with a genetic counselor. He or she will be able to tell you more about the chances that your baby will have clubfoot.

How is clubfoot diagnosed?

In most cases, clubfoot is diagnosed after your baby is born. Your doctor will be able to identify clubfoot based on the appearance of your baby’s foot. Sometimes after a visual inspection of the foot, they may also order an X-ray to confirm the diagnosis.

Clubfoot also can be discovered in utero (while the baby is still in the mother’s womb) during an ultrasound. An ultrasound is a type of imaging used to look at babies in the womb. It is routine for a woman to have an ultrasound during her pregnancy to confirm her baby’s growth and development.

Even if clubfoot is discovered in utero, there is nothing that can be done to correct it until after the baby is born.

Can clubfoot be prevented or avoided?

You cannot prevent clubfoot because no one is sure what causes it. You may be able to lower the risk of clubfoot by not smoking or using recreational drugs if you are pregnant.

However, with treatment, your child should be able to participate in a variety of physical activities and lead a normal life.

Clubfoot treatment

There are two primary ways to treat clubfoot. One way involves stretching to reshape the foot. The other involves surgery. Most cases of clubfoot can be successfully treated without surgery.

For most babies, stretching and reshaping the foot is the best treatment option. There are a few reliable techniques for treating clubfoot with stretching. The most widely used is called the Ponseti method. Treatment usually begins as soon as possible after birth, typically within the first week. This is the best and easiest time to reshape the foot.

The Ponseti method

With this method, stretching is used in combination with a cast. Your doctor (or orthopedic specialist) will stretch your baby’s foot toward the correct position and then place a cast on it to hold it there. Every week or so, the doctor will remove the cast, stretch the foot further toward the correct position, and re-cast it. This will continue until the foot is fully in the correct position (usually several months).

Sometimes, the doctor will also need to clip a portion of the Achilles tendon that connects your baby’s heel to his or her calf muscle. Doing so will allow the tendon to grow to a normal length. If this is required, the doctor will do the clipping before putting on your baby’s final cast.

Once the final cast is off, your baby will probably need to wear special shoes and possibly a brace. They won’t have to wear these things forever. It could be several months or even a few years. You’ll also need to continue doing stretching exercises with your baby.

Surgery

When clubfoot is severe, surgery is often the best option for your baby. The surgeon (usually an orthopedic surgeon) will work to lengthen the tendons in the foot and may also need to realign the bones and joints.

Following surgery, your baby will likely also wear a cast for a few months. Your doctor may also prescribe special shoes and a brace for your baby once the cast is removed.

In rare cases, clubfoot is not completely correctable. Most of the time, babies who had clubfoot and received treatment can lead active lives as they get older.

Living with clubfoot

If your child’s clubfoot is not treated, they will not be able to walk normally. It is sometimes possible to walk with clubfoot, but it is very difficult. Children who have clubfoot tend to walk on the sides of their feet. This can cause large callouses and chronic pain.

As your child gets older, having uncorrected clubfoot will mean having a less active lifestyle.

Questions to ask your doctor

• If I had clubfoot, how likely is it that my baby will have it?
• What kind of follow-up care will my baby need?
• Will my baby have full use of the foot after treatment?
• Will my child be able to play sports?
• Are there any long-term side effects of having a treated clubfoot?