16889 Clubfoot

Overview

Clubfoot, also called congenital talipes equinovarus, is a condition present at birth where a baby's foot is twisted out of shape. The foot often points downward and inward, and the sole of the foot may face sideways or even upward. It happens because the muscles, tendons, and bones of the foot do not form correctly early in pregnancy. It is not painful for the baby, but it can cause problems with walking if left untreated.

About 1 in every 1,000 babies is born with clubfoot, making it one of the most common birth conditions affecting the feet. It can affect one foot or both.

Clubfoot affects boys about twice as often as girls. It occurs in all racial and ethnic groups. If you have a family history of clubfoot, your baby may have a higher chance of being born with it.

Symptoms

Common symptoms

• The foot is turned downward and inward
• The foot may be smaller than the other foot
• The calf muscle on the affected side may look smaller
• The foot may feel stiff and not move into a normal position easily

Symptoms in children

• Newborn babies: The foot looks twisted, and the sole may face upward or sideways. This is usually visible right after birth.
• Older babies and children (if not treated): The child may walk on the side or top of the foot, which can cause sores and make walking difficult.
• With treatment, children usually have a pain-free, functional foot and can play and run normally.

Causes

Main causes

• The exact cause is not known. Clubfoot develops during early pregnancy, likely due to a combination of genetic (inherited) and environmental factors.
• The tissues (muscles, tendons, and ligaments) in the lower leg do not grow in the right way, pulling the foot into an abnormal position.

Risk factors

• A family history of clubfoot (if a close relative has it, the risk is higher)
• Being male (the condition is about twice as common in boys)
• Certain genetic or nerve conditions present at birth, such as spina bifida

When to see a doctor

See a doctor urgently if:

• If your baby is born with a foot that looks twisted, tell your doctor or midwife right away. An early referral is key to successful treatment.
• If your child is being treated and the toes turn pale, blue, or very swollen, contact your doctor urgently.

Book a routine appointment if:

• Newborns with clubfoot should see a specialist (an orthopaedic surgeon or a physiotherapist) within the first week or two of life to start treatment.
• Adults with untreated clubfoot who have pain or difficulty walking should see their general practitioner for advice and a possible referral.

Diagnosis

Clubfoot is usually diagnosed by physical examination right after birth. In some cases, it can be seen during an ultrasound before birth. The doctor will gently examine the foot, check its position, and see whether it can be moved toward a normal position.

Tests that may be done

• In most cases, no tests are needed. If the doctor suspects other health conditions, they may recommend an X-ray, ultrasound, or a referral to a genetic specialist. But for clubfoot alone, imaging is not usually necessary.

What to expect at your appointment

Once diagnosed, your baby will be referred to a specialist team with experience in treating clubfoot. The team will explain the treatment plan, usually starting with gentle stretching and casting within the first couple of weeks of life.

Treatment

The standard treatment for clubfoot is called the Ponseti method. It involves gentle stretching, weekly plaster casts, and sometimes a minor procedure to release a tight tendon. After the foot is corrected, a brace is worn to keep the foot in the right position and stop the problem from coming back. This treatment works very well in nearly all babies.

Self-care at home

• Care for the cast: keep it dry and check the edges for roughness that could irritate the skin.
• Do the exercises your physiotherapist shows you, exactly as taught.
• Make sure the brace is worn as long as the specialist advises, even if your child seems fine without it.
• Bring your child to all follow-up appointments.

Medical treatments

The specialist will move the baby's foot gently into a better position and then apply a plaster cast to hold it there. This is repeated once a week for about 5 to 10 weeks. After the foot is mostly corrected, a minor procedure called a tenotomy (a small cut to release a tight heel tendon) may be done in the clinic or operating room. After that, the baby wears a brace (sometimes called 'boots on a bar') full-time for about 3 months, then at night for a few years. This prevents the foot from returning to the original position.

When is surgery considered?

Most babies do not need major surgery. If the foot is very stiff or does not correct with casting, a more involved operation may be considered. However, with early and consistent treatment, this is rarely necessary.

Living with this condition

With successful treatment, clubfoot should not stop your child from living an active life. Most children walk, run, play sports, and wear regular shoes. The affected leg and foot may be slightly smaller, but this rarely causes problems. Your child may just need to pay a little extra attention to choosing comfortable footwear.

Lifestyle tips

• Encourage your child to be physically active from a young age.
• Choose shoes that are comfortable and supportive, with enough room for the toes.
• Let your child learn how to check their feet for any sore spots or pressure marks as they grow older.
• Keep in touch with your specialist team until your child's foot is fully grown, usually around age 4 to 5, to make sure the correction holds.

Diet and exercise

There is no special diet for clubfoot. A healthy, balanced diet benefits every child. After treatment, your child can do all kinds of exercise and sport. If they notice any discomfort, a physiotherapist can suggest specific stretches or strengthening exercises.

Mental health and emotional wellbeing

Learning that your baby has clubfoot can feel overwhelming, but remember that it is very treatable. As children grow, some may feel self-conscious about scars or a smaller foot. Talk openly and positively with your child, and if they feel anxious or upset, consider speaking with a school counselor or a child therapist. Many families find it helpful to connect with others who have gone through the same experience.

Prevention

Clubfoot cannot be prevented. It develops very early in pregnancy, and there is nothing you did to cause it. You can, however, help by starting treatment as soon as possible after birth.

Complications

If left untreated

• Walking problems: The child may stand or walk on the side or top of the foot, which is painful and unstable.
• Difficulty finding shoes that fit properly.
• Arthritis and chronic pain in the foot and ankle in later life.
• Pressure sores and calluses from unusual weight-bearing.

Long-term outlook

The outlook for babies born with clubfoot is excellent. With early treatment, more than 90% of children achieve a near-normal, functional foot that is pain-free and allows them to run, play, and wear ordinary shoes. Some differences in foot size and calf muscle may remain, but they rarely limit daily life.

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