Clubfoot is a congenital deformity which occurs in approximately in 1 of every 1000 babies. The foot has the appearance of pointing downwards and twisted inwards. Since the condition may start in the first trimester of pregnancy, the deformity is quite established at birth, and is often very rigid. One or both feet may be affected, and it is two times more common in boys than girls. This creates a foot which has been described as "kidney shaped", with a prominent medial crease along the plantar aspect of the foot.

What causes clubfoot?

The majority of clubfeet result from abnormal development of the muscles, tendons and bones while the baby is forming in the uterus. The disturbance in normal growth of the foot probably occurs at about the eighth week of pregnancy. The exact cause remains unknown, but it is believed that heredity may play a part. Shortened tendons on the inside of the lower leg together with abnormally shaped bones that restrict movement outwards cause the foot to turn inwards. A tightened achilles tendon causes the foot to point downwards. Clubfeet can be associated with congenital deformities such as amniotic band syndrome, myelodysplasia, dwarfism, and arthrogryposis. Your child’s doctor will evaluate your child for any associated syndrome.

What are the symptoms of clubfoot?

Clubfoot does not cause pain in the infant. If left untreated, the deformity does not go away. It gets worse over time, with secondary bony changes developing over years. The affected child bears weight along the lateral foot, rather than on the sole. An uncorrected clubfoot in the older child or adult is unsightly, disabling, and very difficult to treat.

What can your doctor do about it?

The first step in the management of clubfoot is casting. About 80% of clubfeet will respond to this conservative therapy (Ponseti Method). Initial treatment consists of gentle manipulating the foot to get it to the best alignment possible and holding this correction in a cast. The cast is usually changed weekly, with manipulation before each casting, to obtain further correction. After 4-6 weeks of casting, a percutaneous heel cord tenotomy is performed in the operating room and a new cast is applied which stays on for three weeks. When the cast is removed a foot abduction brace is worn full time with special shoes until the child is about 6 months of age. From 6 months of age until age 2 years the brace is worn at night.

The treatment should begin in the first week or two of life in order to take advantage of the elasticity of the tissues forming the ligaments joint capsules and tendons. The goal of treatment is to achieve and maintain as normal a foot as possible. Treatment may take several months, but most children learn to crawl, stand and walk at the normal age.

In about 90% of cases, manipulation and casting is successful, and the foot can be placed in a brace to hold the correction. In about 20% of cases, manipulation and castings alone do not correct the deformity completely and a decision will be made regarding further castings, or surgery.

If the Ponseti method fails, which is unusual, surgery may be required. This consists of releasing all the tight tendons and ligaments in the posterior (back) and medial (inside) aspects of the foot and repairing them in the lengthened position. Metal pins may be used to hold the bones in place for six weeks and to help maintain the correction. It involves an overnight day stay in hospital, and parents may stay in the child’s room. After surgery, the foot needs to be casted for up to 12 weeks, followed by the use of a brace to hold the correction. This brace is used for about 6 to 12 months after surgery.

What can be expected after treatment?

The goal of treatment is to provide your child with a working foot that looks as normal as possible. Therefore, close follow-up is needed. Most children with clubfeet have some slight stiffness in the ankle, about a one shoe size difference in foot size, a slightly skinnier calf muscle and occasionally a small leg length difference. Sports, exercise, and corrective surgery can be used to strengthen and realign the foot, but there is a small distinct difference between the normal side and the clubfoot. The well-treated clubfoot is no handicap and is fully compatible with a normal, active life. Most children who have been treated for clubfeet develop normally and participate in any athletic or recreational activity that they choose.