Clubfoot overview

Overview

Clubfoot is a condition where a baby is born with one or both feet twisted out of shape or position. The foot points down and inward. It is not painful for the baby, but it can affect walking if not treated.

Clubfoot is one of the most common birth conditions affecting the feet. About 1 in every 1,000 babies is born with clubfoot.

Clubfoot affects babies from birth. It can run in families and is more common in boys than girls.

Symptoms

Common symptoms

• One or both feet turned downward and inward.
• The foot may look like it is on the wrong side (upside down).
• The calf muscles on the affected leg may be smaller.
• The foot may be shorter and wider than normal.

Symptoms in children

• If not treated, a child may walk on the side or top of the foot.
• Walking may become painful or difficult.

Symptoms in older adults

• Adults who did not receive treatment may have chronic foot pain or arthritis.
• Walking may be affected, and the foot may feel stiff.

Causes

Main causes

• The exact cause is unknown, but it is thought to be a combination of genetic and environmental factors.
• The tendons and ligaments in the foot are shorter than normal, pulling the foot out of position.

Risk factors

• Family history of clubfoot.
• Being male (more common in boys).
• Maternal smoking during pregnancy.
• Certain genetic conditions, such as spina bifida.

When to see a doctor

See a doctor urgently if:

• If you notice your baby's foot looks twisted or turned inward shortly after birth.

Book a routine appointment if:

• If you have any concerns about your baby's foot shape or movement, talk to your pediatrician at a routine visit.

Diagnosis

Clubfoot is usually diagnosed at birth by a physical exam. Sometimes it is seen on an ultrasound before birth.

Tests that may be done

• Physical exam to check the foot's position and flexibility.
• Sometimes X-rays to see the bones.

What to expect at your appointment

The doctor will examine the foot and discuss treatment options. Treatment usually begins within the first two weeks of life.

Treatment

Treatment starts soon after birth. The most common method is the Ponseti method, which uses gentle stretching and a series of casts to gradually move the foot into the correct position. After the foot is corrected, a brace is worn for a few years to prevent the foot from turning back.

Self-care at home

• Follow the cast and brace instructions carefully.
• Keep the brace clean and dry.
• Do not remove the brace without advice from your healthcare provider.
• Watch for signs of skin irritation or rubbing from the brace.

Medical treatments

Doctors use a series of casts to slowly reposition the foot. A small procedure called a tenotomy (cutting a tendon) may be needed to help the foot straighten further. After casting, a brace (often called 'boots and bar') is worn at night and during naps for several years. In rare cases, surgery may be needed if casting is not enough.

When is surgery considered?

Surgery is sometimes considered if the clubfoot is very stiff or if treatment is started late. The procedure involves lengthening tendons and adjusting bones. Most babies do not need major surgery with early Ponseti treatment.

Living with this condition

With treatment, children with clubfoot can lead active, normal lives. They can walk, run, and play sports. The brace may be a bit inconvenient but is crucial for success.

Lifestyle tips

• Be consistent with brace wear as recommended.
• Attend all follow-up appointments.
• Encourage your child to be active and participate in activities.

Diet and exercise

No special diet is needed. Regular exercise and physical activity are encouraged as the child grows. The treated foot can handle most activities.

Mental health and emotional wellbeing

Having a baby with clubfoot can be stressful for parents. It's important to get support and talk to other parents. The child may feel different because of the brace, but most adapt well. If you or your child feel anxious or upset, talk to a doctor or counselor.

Prevention

There is no known way to prevent clubfoot, but avoiding smoking during pregnancy may lower the risk.

Vaccines

Not applicable.

Screening programmes

Ultrasound during pregnancy may sometimes detect clubfoot, but not all cases are seen.

Complications

If left untreated

• Without treatment, the foot remains twisted, making walking difficult and painful.
• The child may walk on the side or top of the foot, causing calluses, sores, and arthritis over time.

Long-term outlook

With early treatment, the outlook is excellent. Most children have a functionally normal foot and can participate in all activities. Some may have a slightly smaller calf or foot, but this usually does not cause problems.

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