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Clubfoot
Definition:
Clubfoot is a relatively common condition, visible at birth, where one or both feet are abnormally positioned. Usually the baby is otherwise completely healthy. Clubfoot can be mild, moderate or severe, and as the condition will cause future difficulties if untreated, it is important to begin remedial treatment as soon as possible.
The medical term for clubfoot is talipes equinovarus, taken from talus (ankle) and pes (foot), as the position of the foot means that the person would have to walk on the outside of the ankle, and equino (indicating that the heel is raised, as in a horse’s hoof) and -varus (turned inward).
Causes:
About 1 in every 1000 babies is born with clubfoot. It is an idiopathic condition, meaning that the cause is unknown, although there are predisposing factors:
- There is a genetic factor in the development of clubfoot, and if you or your spouse had it, or any of your other children, there is an increased risk of a new baby also having the condition.
- Males are slightly more likely to have clubfoot than females.
- If a pregnant woman has a family history of clubfoot, and she smokes during pregnancy, the baby is 20 times more likely to be born with the condition.
It is known that clubfoot is not caused by the position of the baby while still in the womb.
Symptoms:
Clubfoot is not a painful condition. Left untreated it will cause complications with walking and wearing normal footwear, which would quickly lead to the development of painful symptoms.
Usually a clubfoot is twisted so that the top of the baby’s foot points down and inward. Sometimes the twisting can be so severe that the foot appears to be upside-down. The foot cannot be straightened by just moving the foot because the associated joints, muscles and ligaments are holding the foot in the distorted position.
The calf muscles of the affected limb are often underdeveloped, and the clubfoot may be shorter than the normal foot.
Diagnosis:
The presence of clubfoot is usually immediately apparent at birth, due to the position and shape of the foot or feet. X-rays might be taken of the feet to assess the severity and aid decision-making with regard to treatment.
Sometimes clubfoot may be diagnosed during a normal ultrasound examination of the fetus while still in the uterus.
Treatment:
A newborn baby’s bones and joints are very flexible. This makes early treatment the best option for the most successful outcome. The aim of treatment is to restore optimum position and function of the foot to avoid problems when the baby begins to walk. Left untreated, the child would be forced to stand and walk on the outside of the foot. This could lead to sores and calluses, the likelihood of arthritis, and quite severe disability.
Parental involvement and willingness to follow medical advice is critical, as failure to adhere to the program will result in the baby’s foot reverting to its original clubfooted position.
There are three methods of treating clubfoot: the Ponseti method, the French method, and surgery. Which option is chosen will depend on the initial level of severity, the orthopedic surgeon’s recommendation, and parental choice. In some cases both the Ponseti and French methods might be employed.
The Ponseti method involves stretching and casting. The bones and joints of the foot are gradually encouraged into the correct alignment by manipulating them towards the right position and placing the foot in a hip to toe cast to maintain the stretch. The cast is removed every five to seven days, the foot manipulated further towards correctness, and a new cast applied. The process continues for six to eight weeks until the foot is in a normal position. For final correction, at this point the Achilles tendon is often cut and a cast applied to be worn for three further weeks. By the time this cast is removed, the tendon has repaired itself and is a proper length. Subsequent treatment involves stretching exercises and wearing a splint full-time for three to four months, then at night for three to four years. The splint is comprised of a bar with shoes at either end. Special shoes would be worn during the day. Excellent results can be obtained by strictly following all the elements of the technique.
The French method works by manipulating the foot on a daily basis, followed by taping to hold the foot in position until the next day. This procedure continues for three months, after which the taping sessions are reduced to three times a week for another three months. When the optimum position has been achieved, the parents must perform daily stretching exercises on the baby’s foot, and apply a splint to be worn each night. This continues until the baby begins to walk. The French method is equally successful, but is chosen less frequently due to the difficulties of daily appointments for treatment.
Surgery is necessary for some cases of clubfoot. Tendons can be lengthened, which would allow the foot to assume a more correct position. Following surgery, the baby would have to wear a brace for at least a year in order to avoid the foot reverting to the original deformed position. Surgery for clubfoot does result in some scarring, stiffness and muscle weakness.
Sometimes clubfoot cannot be completely corrected, and the size of the foot and calf muscles in the affected leg may remain smaller than the other leg. This does not usually affect foot and ankle function and in most cases early treatment will mean that your child will be able to wear normal shoes, enjoy an active life, and participate in sports.
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