All about clubfoot in children

Clubfoot is a congenital condition that affects the bones, muscles, tendons and blood vessels of the foot. The forefoot of the foot curves inward while the heel points downward. In extreme conditions, the foot is rotated to the point where the bottom of the foot is rotated up or sideways rather than down.

Many parents discover that their child has clubfoot during a prenatal ultrasound months or weeks before birth. Once the child is born, the problem is obvious. Ideally, treatment should begin within the first month of a child’s life.

The good news is that the vast majority of children with clubfoot who receive early treatment can run, play and function normally. Without therapy, however, clubfoot will not improve. The foot will remain in the malformed posture, making walking difficult for your child.

What symptoms accompany clubfoot?

If only one foot is affected:

  • The calf muscle of the affected leg is smaller than that of the other leg.
  • The affected leg is often shorter than the unaffected leg.
  • The affected foot may be short and wide.

Who is at risk of contracting clubfoot?

Most children with clubfoot do not inherit the condition from their parents. However, having an older sibling with clubfoot increases the likelihood of a child being born with the condition.

  • If a boy has clubfoot, his older brother has a 2.5% risk of inheriting the condition.
  • If a girl has clubfoot, her older brother has a 6.5% chance of being born with clubfoot.

Additional risk elements include:

  • Male gender; men are twice as likely as girls to be born with clubfoot.
  • Neuromuscular diseases, including cerebral palsy (CP) and spina bifida
  • Birth defects including arthrogryposis and amniotic band syndrome
  • Oligohydramnios (reduction in the amount of amniotic fluid around the fetus in the womb during pregnancy)
  • Breech birth (the fetus is delivered from the bottom rather than the head)

Babies born with clubfoot may also be more likely to get developmental dysplasia of the hip (DDH). In DDH, the femur slips in and out of its socket because the socket is too shallow to maintain the integrity of the joint.

What causes clubfoot?

Most clubfeet are idiopathic, which means doctors aren’t sure what caused them. Clubfoot is most likely inherited and runs in families. However, researchers do not yet know which gene(s) are responsible.

The tightness of the muscles and tendons surrounding the foot and ankle keeps the foot in its distinctive downward and inward posture in all children with clubfoot. This tension can be caused by variations in blood flow or nerve signal reception in the affected legs. Other hypotheses about the etiology of clubfoot include problems with bone, tendon, or muscle development, as well as mechanical obstruction in utero. However, these theories remain unverified.

In some cases, clubfoot is a symptom of a congenital condition or defect. In other cases, the foot was incorrectly positioned in the uterus. However, most children are born with clubfoot for unknown reasons.

How is clubfoot diagnosed and treated?

Typically, clubfoot is detected during a prenatal ultrasound before the birth of a child. Around 10% of clubfeet can be detected as early as 13 weeks pregnant, while around 80% of clubfeet can be diagnosed at 24 weeks.

If a child is not diagnosed before delivery, clubfoot can be seen and diagnosed at birth. Generally, a physical examination is sufficient to establish a diagnosis. In rare cases, additional tests, including:

  • x-ray
  • Computed tomography examination (CT or CAT scan)

How is clubfoot treatment given?

The goal of clubfoot treatment is to restore the position of the foot so that the bones, tendons, and muscles can develop normally. Ideally, treatment should begin within a month of a child’s birth, when their feet and ankles are at their earliest stage of development.

Ponsetti method

The Ponseti technique is the most common and effective treatment for clubfoot. This treatment uses a series of casts and orthoses to correct the position of the infant’s foot. The foot is rotated outwards until it is rotated between 60 and 70 degrees. Typically, treatment begins between birth and four weeks of age and consists of two phases: treatment and bracing.

Treatment period

Using a series of casts, the doctor will gradually realign your child’s foot during the treatment phase. This stage involves stretching and repositioning the foot for two to three months.

  • The doctor will stretch and realign your child’s foot before molding the foot, ankle, and leg to maintain the new position.
  • After about a week, the doctor will remove the cast and realign your child’s foot. The foot will be held in its new position by a new cast.
  • This method will be continued each week until your child’s foot is in the correct outside position rather than the wrong inside position. Typically, five to eight readjustments and cast replacements are needed to get the foot into the correct position.
  • When the foot is in its improved outward position, the Achilles tendon in the majority of young people needs to be lengthened by minor surgery (tenotomy). It is the tendon connecting the calf muscle to the heel. About 95% of infants need this procedure, which is usually performed under local anesthesia.

Bracing for clubfoot is essential to your child’s long-term mobility and lasts for many years. The orthosis keeps your child’s foot in the correct position. From the end of the treatment phase until the age of three to six months, your child will wear the corset for approximately 22 hours a day.

After this initial period, your child’s doctor will likely allow the brace to be worn at night and during naps, about 15 or 16 hours a day. When your child is ready to learn to crawl, walk, run and play, the brace can be removed.

Good to know: You must fully adhere to the treatment regimen until your child reaches the age of four. This is the most effective approach to prevent your child’s foot from twisting again and requiring additional medical treatment despite the inconvenience.

What is the prognosis for newborns born with clubfoot?

The vast majority of infants with clubfoot who receive early therapy and bracing develop typical functioning feet. They can run and play while wearing regular shoes. If only one foot is affected, the affected foot will usually be smaller and less mobile than the unaffected foot. Your child may need shoes in two different sizes. The affected leg may be slightly smaller than the other and the calf may be less muscular.

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