What Is Clubfoot?
Clubfoot, also known as talipes equinovarus is a congenital condition—present at birth—in which an infant’s foot is turned inward and downward. The condition can be so severe that the top of the foot faces sideways or down.
Clubfoot is one of the most common congenital musculoskeletal deformities, affecting about one child in 1,000. The condition is not painful for a baby, but it should be corrected within the first year of life, or it will be difficult (or impossible) for the child to learn to walk.
Causes and Risk Factors
Congenital clubfoot is caused by tendons and ligaments that connect leg muscles and foot bones being too tight. This pulls the foot out of its natural position. The result is that the foot rests naturally in a position resembling the head of a golf club, which is where the condition gets its name.
There are three main components of a cluboot:
- The front of the foot is turned inward
- The back of the foot is also turned inward
- The Achilles tendon is tight causing the foot to point downward
The clubfoot deformity also involves the entire leg and the involved leg and foot is slightly smaller than the other side.
Boys are about twice as likely as girls to be born with clubfoot. The exact cause of the disease is unknown, but most experts believe it to be caused by a mixture of genetic and environmental factors.
People with a family history of clubfoot are more likely to be born with the condition. Most researchers believe smoking, drinking alcohol or using drugs while pregnant may contribute to an increased risk of the baby being born with clubfoot. Sometimes it is seen with other musculoskeletal disorders such as spina bifida.
Since the condition is not painful, symptoms of clubfoot are largely cosmetic for babies who cannot yet walk. The foot is turned inward at varying degrees depending on severity, and there is usually a large crease across the bottom of the foot. About half the cases of talipes equinovarus affect both feet.
The condition has more severe consequences if it is not corrected before the child begins learning to walk. Children with clubfoot may not be able to walk at all, or have a severely affected gait. Making adjustments necessary to walk with clubfoot can also cause further problems, such as muscle imbalances or sores and calluses on the foot. Uncorrected clubfoot also puts the child at increased risk of arthritis.
Clubfoot is very often diagnosed in the womb during a routine ultrasound. It can be detected at as early as 18 weeks gestation. If it is not caught in the womb, it is usually identified immediately after birth.
Because babies’ bones and joints are softer and more malleable at and after birth, treating clubfoot is best started early. Treatment is generally started in the first few weeks after birth, but casting of the foot can be successful for children when treatment is started later, before the child learns to walk. Many cases of clubfoot are treated predominately nonsurgically. The goal is avoiding large surgeries to the foot which can lead to stiffness and pain.
The most common form of clubfoot treatment is known as the Ponseti (serial casting) method. A doctor will position (stretch) the baby’s foot and put it in a cast to hold it in place. The foot will be repositioned and re-casted once every 7-10 days for a total of 4-6 sets of casts to obtain correction of the foot.
Before placing the last cast, a surgeon may perform a minor procedure to lengthen the baby’s Achilles tendon if the tendon remains tight. After the foot is corrected, the correction needs to be maintained with the use of a Ponseti foot abduction bar and shoes. The parents will also stretch the foot to keep it flexible. Special shoes or braces may be used also to avoid recurrence.
For severe clubfoot that does not resolve with the Ponseti method or that returns after conservative treatment, surgery may be necessary. Surgical options can include the Achilles lengthening or an anterior tibial tendon transfer, which involves moving a tendon on the front of the ankle.
A more extensive foot reconstruction surgery can be used for the most severe cases of clubfoot. This involves cutting and lengthening of multiple ligaments and tendons, then stabilizing the foot with pins and a full-length cast. After the foot is stabilized in four to six weeks, the long-leg cast is replaced by a short-leg cast for another four weeks. Special shoes and braces will still need to be worn for up to a year after surgery. This type of surgery has been largely avoided once the Ponsetti casting method became widely adopted.