Clubfoot

Because clubfoot is caused by an Achilles tendon that is too short and tight, the foot always appears pointed. The tendon also causes the foot to turn in and under. In severe cases, the clubfoot may be turned so far under that the bottom of the foot faces completely up and the foot looks as though it’s upside down. A baby with clubfoot may also have underdeveloped calf muscles. If the baby has just one clubfoot, that foot may be up to a half-inch shorter than the other. In some cases, clubfoot causes the leg to be slightly shorter than the other leg.

Doctors can usually visually diagnose clubfoot at birth, but the condition is often detected in utero (in the womb) with ultrasounds. The doctor might also take an X-ray of the foot to confirm a clubfoot diagnosis. It is important to get an early diagnosis and treat clubfoot as soon as possible so walking will not be impaired as the child grows. 

Doctors don’t know the cause of clubfoot, but research suggests it may be a combination of genetic and environmental factors. Most cases of clubfoot are idiopathic, meaning they have no known cause and appear in an otherwise healthy baby. Clubfoot is usually present at birth, but babies with other health conditions, such as spina bifida, cerebral palsy, or connective tissue disorders, could develop clubfoot later.

The risk factors for clubfoot include:

• Male gender

• Family history of clubfoot, such as a parent or sibling with the condition

• Smoking during pregnancy

• Using recreational drugs during pregnancy

• Too little amniotic fluid surrounding the baby during pregnancy, which is oligohydramnios

• Other skeletal birth defects

Since doctors aren’t sure what causes clubfoot, it’s important to minimize the risk factors you can control, including not smoking and not using drugs during pregnancy.

With clubfoot treatment, most babies lead active lives without long-term disability. It’s important to begin treatment as early as possible, beginning when the baby is only a week or two old. However, successful treatment of older babies is possible. Nonsurgical treatment is preferred because clubfoot surgery usually causes the foot to be stiffer as the child grows.

One type of nonsurgical treatment—the Ponseti method—involves repeatedly stretching and casting the baby’s foot in the proper position. A foot and ankle specialist will perform the procedure. The doctor casts the foot approximately every week for six to eight weeks. A tiny cut in the Achilles tendon—an Achilles tenotomy—will let the tendon grow to the correct length. The baby will need to wear a brace for up to four years after clubfoot correction so that the problem does not recur. Stretching exercises will also help.

The French method is another nonsurgical clubfoot treatment involving physical therapy and splinting. The baby will need to see a physical therapist about three times a week for the first three months. The therapist will teach the parents or caregivers how to properly stretch the baby’s foot. The stretches must be done every day for this method to be successful. After stretching and manipulating the baby’s foot, caregivers must then tape the baby’s foot into the right position and put on a plastic splint. The baby will usually need to have an Achilles tenotomy as well. Stretching, taping and splinting will need to continue daily for several years to prevent the clubfoot from recurring.

In severe cases, or when nonsurgical clubfoot treatment is not successful or unlikely to be, surgery may be necessary to correct the deformity. Surgical clubfoot repair involves several steps:

1. Surgically release (reposition) several of the foot’s soft tissue structures to allow the Achilles tendon to lengthen.

2. Stabilize the baby’s joints with small pins. The baby will get a long leg cast to protect the soft tissue as it heals.

3. Remove the pins and cast after four to six weeks. The baby will have a short leg cast for about a month.

4. Custom fit a brace for the child. The baby will need to wear the brace either full time or only at night for at least a year after surgery to prevent the clubfoot from recurring.

Sometimes, doctors use nonsurgical treatment to correct clubfoot as much as possible, then follow up with less extensive surgery to completely correct the tendons and joints in the foot and ankle.

Clubfoot won’t get better on its own, and without treatment, the child could have lifelong disabilities. The child will not be able to walk with a normal gait and will have a higher risk of developing arthritis.

People may still have complications even after clubfoot treatment. They might not have a completely normal gait, and they might notice that the corrected clubfoot is smaller than the other foot. The leg might also be slightly shorter, and the calf may be smaller on that side. If bracing is not used consistently as the clubfoot heals, the problem could recur and need surgical treatment.

Complications from clubfoot surgery could include overcorrection of the problem, pain, and stiffness.