Overview

What is clubfoot?

Clubfoot is a birth defect that occurs when a baby's foot or feet turn inward. When you look at their foot, the bottom often faces sideways or even up. Another name for clubfoot is Talipes Equinovarus. Clubfoot is a very common congenital condition. About 1 in every 1,000 babies will have clubfoot.

What are the different types of clubfoot?

There are two kinds of clubfoot:

Isolated or idiopathic clubfoot: This is the most common type. If your child has clubfoot with no other medical issues, it's called isolated clubfoot. Idiopathic means that the cause of clubfoot isn't known.
Nonisolated clubfoot:Nonisolated clubfoot can occur as part of another medical condition. They most frequently consist of two conditions, both of which include arthrogryposis, also known as a problem in the joints; on the other hand, spina bifida is a neural tube disorder. The term is used to describe the problems that develop in the brain, spine, and spinal cord of your baby.

What are the symptoms of clubfoot?

Additionally, you might see that their foot has a:

Kidney-like shape.
Deep grooves on the inside.
An abnormally high arch is also known as a cavus foot deformity.

Other symptoms of clubfoot that you might experience include:

Smaller one of the calf muscles of the affected leg
Shorter in length
Immobile ankle
Their foot cannot move fully.

What causes clubfoot?

Researchers do not know what causes clubfoot. Probably, there is interaction between environment and heredity:

Hereditary: Genes decide how your baby's body will come to be, how it will look, and how it will function. An error within one or more genes may cause clubfoot. An error in one or more genes can be passed from parents to their offspring.
Environment: Exposure to tobacco smoke and drug use by a woman during pregnancy may increase the risk for a baby to be born with clubfoot, a birth defect.

Who is at risk for clubfoot?

Clubfoot is found in around twice as many boys than it is in girls. If your baby has a family history of clubfoot, then their risk increases too.

Additionally, if any of the conditions below are present, babies tend to be more susceptible:

Another birth defect, such as cerebral palsy or spina bifida.
A genetic condition, such as Edward syndrome (trisomy 18).

You are at an increased risk of having a child with clubfoot if:

You experienced oligohydramnios during pregnancy. This is due to a deficiency in amniotic fluid (the fluid surrounding the fetus).
You had a Zika infection during pregnancy. The impacts include birth defects and other complicated issues.
Used drugs, cigarettes, or alcohol while pregnant.

When and how is clubfoot diagnosed?

A doctor often detects it during an ultrasound while you are pregnant. A prenatal ultrasound contains images of the fetus as it develops. If clubfoot is diagnosed while pregnant, you can start making arrangements for the treatment that will be necessary when your child is born.

Other times, your provider can diagnose clubfoot after your baby is born. Often, they find it in one of your baby's first physical exams. Your provider may do an X-ray to confirm the diagnosis.

How is clubfoot treated?

The aim of treating clubfoot is to arrange the foot so that bones, tendons, and muscles grow more normally. Ideally, treatment is started within one month of a child's birth; this will allow their feet and ankles to be at the earliest possible stage of development.

Ponseti Serial Casting: This treatment includes careful stretching and manipulation of the foot followed by holding it with a cast using the Ponseti technique. The first cast is done one to two weeks after birth. This cast is then changed every 7 to 10 days. Around the fourth or fifth cast, a minor procedure is also required to help lengthen the Achilles tendon, which is done with a numbing local medication and a small blade. Then, the baby is placed into a final cast that will remain for two to three weeks.

Bracing for Clubfoot: While the cast corrects the foot deformity, bracing holds the correction in place. If not braced, the clubfoot would recur. The day the last cast is removed, the baby is fitted in a supra malleolar orthosis with a bar. These braces are worn 23 hours a day for two months, then 12 hours a day (naps plus nighttime) until the baby reaches kindergarten age.

Surgery: Sometimes, a child has severe clubfoot. Or you've tried nonsurgical methods, but they haven't worked. Surgery can correct the problem. It's best if your child has the surgery before they start walking. During the procedure, the surgeon:
Lengthens your baby's heel cord and fixes other problems with their foot or feet.
Places pins in their foot to correct the position.
Places a cast on their foot after the surgery.

3 weeks to 6 weeks after surgery, the surgeon:

Removes cast and pins.
Applies a new cast to your child's foot, which your child wears for about another 4 weeks.
After surgery, the foot may still return to the clubfoot position. Your doctor may recommend bracing or special shoes to keep the foot aligned properly.

What are the complications of clubfoot surgery?

Complications of operative treatment of congenital clubfoot include:

Nerve damage
Infection
Bleeding
Stiffness

Can clubfoot be prevented?

Since doctors do not know what causes clubfoot, you cannot prevent it entirely. But if you are pregnant, you can do several things to reduce your baby's risk for birth defects by:

Not smoking or staying in smoky places
Not drinking alcohol
Avoid drugs that are not approved by your doctor

What is the long-term outlook for babies with clubfoot?

Although clubfoot does well with treatment, it never gets better without it. The condition worsens progressively with age if left untreated; hence, your child finds walking significantly difficult. With this in mind, treatment must start early, and bracing instructions must be followed closely.