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 2000 births every year in babies born in South-Africa 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 with no additional health problems. In a small percentage of births, it occurs as part of a more serious condition like spina bifida.

Know that having 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.

They include:

  • A foot that turns inward and downward, with toes pointing toward the opposite foot.
  • The clubfoot may be smaller than the other foot (up to ½ inch shorter).
  • The heel on the clubfoot may be smaller than normal.
  • In severe cases, the clubfoot may be twisted upside down.
  • The calf muscle on the leg with the clubfoot will be slightly smaller.

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 the majority of 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 orthopaedic 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).Once the final cast is off, your baby will probably need to wear special shoes and possibly a brace. He or she 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.

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Outcomes

Your baby’s clubfoot will not get better on its own. With treatment, your child should have a nearly normal foot, and he or she can run and play and wear normal shoes.

The affected foot is usually 1 to 1-1/2 sizes smaller and somewhat less mobile than the normal foot. The calf muscles in your child’s clubfoot leg will also stay smaller, so your child may complain of “sore legs” or getting tired sooner than peers. The affected leg may also be slightly shorter than the unaffected leg, but this is rarely a significant problem.

FAQ

Most frequent questions and answers

Most Club foot is called ‘idiopathic’ –or talipes equinovarus, is a complex deformity that is readily apparent at birth and affects the muscles, ligaments, bones and joints of the developing foot and ankle. The ankle is rotated downward and the toes point inward towards the opposite leg. All foot bones are usually present, but are out of normal alignment. All of the foot and leg muscles are also present, but some are smaller and weaker than normal. Tendons and ligaments are contracted, especially behind the ankle and along the instep.

Many parents ask this question. It helps to understand that clubfoot is among the most common of birth defects.
Worldwide, more than one baby in a thousand is born with this foot deformity. That may not sound like a lot, but it is: every year more than 100,000 babies worldwide are born with a clubfoot or clubfeet. Fifty percent of cases affect one foot, and fifty percent affect both feet. Boys are more commonly affected than girls. Sometimes clubfoot runs in families. It also helps to understand that clubfoot responds well to treatment. When treated by medical experts, children born with clubfeet and no other significant medical problems will have feet that are capable of a normal, active life.

Children with clubfeet corrected by the Ponseti Method grow up to have feet that are almost normal in shape and function. For children with one clubfoot, the corrected foot and calf may be slightly smaller. Children with corrected clubfeet grow normally and are able to participate in most sports or leisure activities. Studies in adults show that patients treated using the Ponseti Method continue to have as strong and as healthy feet as adults born with normal feet.

Babies suspected of having clubfoot at the newborn exam are usually referred right away to the orthopaedic team or clubfoot clinic. Infants are seen within a few weeks and treatment begins.

Clubfeet have a stubborn tendency to relapse, or come back, after casting correction. To prevent relapse, your doctor will prescribe a brace to hold the foot or feet in the corrected position after removal of the last cast. The brace is worn 23 hours per day for two to three months, allowing an hour for brace-free bathing and cuddling, and then during night time and naps until the child is approximately four years old.

Sometimes the duration of brace wear will vary (up to six years of age) depending on the severity of the clubfoot and its tendency to relapse. This will be determined by your doctor as your child grows. The brace, called a foot abduction brace because it “abducts” or rotates the foot or feet outward, looks like two shoes connected by a bar. This simple design is effective in holding the feet in the corrected position. Normal shoes are fine for the child to wear when not wearing the brace.

The foot abduction brace is the only brace that prevents relapse and is over 90% effective, if used as prescribed. Wearing the brace will not significantly delay your child’s development with regard to sitting, crawling, or walking. However, NOT wearing the brace will significantly compromise the correction of the clubfoot or feet.