What is it?
Clubfoot, or talipes equinovarus, is a deformity of the foot. In clubfoot, the foot is twisted down and inwards, because the muscles, tendons and ligaments of the foot are abnormally short and tight. It can affect one or both feet.
Clubfoot is not painful for newborns, but treatment is needed in all cases to correct the deformity. If the foot remains deformed, the child will not be able to walk normally, and can develop lifelong physical limitations and pain.
With treatment almost all children have feet that allow them to participate fully in all normal activities.
Who gets it?
Clubfoot occurs in about one in every 1000 births. The exact cause of clubfoot is not known, but boys are almost twice as likely as girls to be born with clubfoot.
In families with one affected child, there is a 1 in 30 chance that a second child will be born with clubfoot. Both feet are affected in about 50% of children with clubfoot.
There are two major types of clubfoot:
Isolated (idiopathic) clubfoot – this is the most common type, and occurs in children with no other physical or medical issues.
Non-isolated clubfoot – this occurs in children with associated health issues or neuromuscular problems, such as spina bifida or arthrogryposis. These types of clubfoot can be more difficult to treat and may require more time and more interventions.
What does clubfoot look like?
Clubfoot varies from mild to severe. In all cases, the foot is turned down and inwards, with an increased arch and a deep crease on the sole of the foot. The affected foot and calf is often shorter and smaller than usual. This is more obvious when only one foot is affected.
What tests are needed?
Clubfoot is usually diagnosed by appearance at birth, but can often be diagnosed beforehand using prenatal ultrasounds. Children with clubfoot may occasionally require X-rays to determine how severe the deformity is, but this is not usually necessary.
How is it treated?
Because newborns have very flexible joints, muscles and tendons, treatment of clubfoot begins as early as possible. The initial treatment is non-surgical in all cases of clubfoot, and involves stretching the foot into a new position and holding it in place.
The most commonly used treatment for clubfoot is known as the Ponsetti method. This technique involves a series of gentle manipulations of the foot into a corrected position. A plaster cast is used to hold the foot in its new position. The manipulations and cast changes may occur weekly for around six weeks. After this, a small surgical procedure is performed to lengthen the tight tendon on the calf, and a final cast is applied to allow the tendon to heal over the next two to three weeks.
For the next three months after casting, babies wear a foot abduction brace 23 hours a day. This holds the feet in the over corrected position. The foot abduction brace is then worn overnight until the child is four years old to achieve the most successful result. Even after successful casting, clubfeet have a tendency to recur. Being very strict about wearing the brace is the best way to maintain the correct position of the foot.
In some cases of clubfoot, the deformity cannot be fully corrected with non-surgical techniques, or the deformity returns. In these children, surgery is sometimes required. Even in children who require surgery, it is important that the deformity is corrected as much as possible through non-surgical methods. This means that the surgery that is required can be as minimal as possible.
Surgery for clubfoot involves releasing or loosening the soft tissue structures (muscles and tendons) that are contributing to the deformity. In many cases this involves releasing the calf tendons or moving the tendons of the foot from one position to another so that they pull the foot into a more natural position. In major surgery for clubfoot, the bones of the foot may be held with pins and a cast while the soft tissues heal.
Even after surgery, clubfoot can recur, so it is important that the child uses special shoes or a brace for a period of time after their operation. The most common side effects of extensive surgery for clubfoot are pain and stiffness of the foot.