About Club Foot

Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your baby's foot is twisted out of shape or position. In clubfoot, the tissues connecting the muscles to the bone (tendons) are shorter than usual. Clubfoot is a fairly common birth defect and is usually an isolated problem for an otherwise healthy newborn.

Clubfoot can be mild or severe. About half of children with clubfoot have it in both feet. If your child has clubfoot, it will make it harder to walk normally, so doctors generally recommend treating it soon after birth.

Doctors are usually able to treat clubfoot successfully without surgery, though sometimes children need follow-up surgery later on

If your child has clubfoot, here's what it might look like

• The top of the foot is usually twisted downward and inward, increasing the arch and turning the heel inward.
• The foot may be turned so severely that it actually looks as if it's upside down.
• The calf muscles in the affected leg are usually underdeveloped.
• The affected foot may be up to 1/2 inch (about 1 centimeter) shorter than the other foot.

More than likely your doctor will notice clubfoot soon after your child is born, based on appearance. Your doctor can advise you on the most appropriate treatment or refer you to a doctor who specializes in bone and muscle problems (pediatric orthopedist).

Risk factors Risk factors include:

Family history. If either of the parents or their other children have had clubfoot, the baby is more likely to have it as well.

Congenital conditions. In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth (congenital), such as spina bifida, a serious birth defect that occurs when the tissue surrounding the developing spinal cord of a fetus doesn't close properly.

Environment. If a woman with a family history of clubfoot smokes during pregnancy, her baby's risk of the condition may be double that of nonsmokers. Also, getting an infection or using recreational drugs during pregnancy can increase the risk of clubfoot.

Not enough amniotic fluid during pregnancy. Too little of the fluid that surrounds the baby in the womb may increase the risk of clubfoot.

Complications

Clubfoot typically doesn't cause any problems until your child starts to stand and walk. If the clubfoot is treated, your child will most likely walk fairly normally. He or she may have some difficulty with:

Movement. Mobility may be slightly limited.

Shoe size. The affected foot may be up to 1 1/2 shoe sizes smaller than the unaffected foot.

Calf size. The muscles of the calf on the affected side may always be smaller than the other side.

However, if not treated, clubfoot causes more-serious problems. These can include:

Arthritis. Your child is likely to develop arthritis.

Poor self-image. The unusual appearance of the foot may make your child's body image a concern during the teen years.

Inability to walk normally. The twist of the ankle may not allow your child to walk on the sole of the foot. To compensate, he or she may walk on the ball of the foot, the outside of the foot or even the top of the foot in severe cases.

Problems stemming from walking adjustments. Walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the foot, and result in an awkward gait.

Prevention Because doctors don't know what causes clubfoot, you can't completely prevent it. However, if you're pregnant, you can do things to limit your baby's risk of birth defects, such as:

• Not smoking or spending time in smoky environments
• Not drinking alcohol
• Avoiding drugs not approved by your doctor

What is Clubfoot?

Clubfoot is a congenital condition (present at birth) that causes a baby’s foot to turn inward or downward. It can be mild or severe and occur in one or both feet. In babies who have clubfoot, the tendons that connect their leg muscles to their heel are too short. These tight tendons cause the foot to twist out of shape.

Clubfoot is one of the most common congenital birth defects. It occurs in about 1 in every 1,000 babies born in the U.S. and affects more boys than girls. In fact, boys are twice as likely to be born with clubfoot.

Usually, a baby born with a clubfoot is otherwise healthy with no additional health problems. In a small percentage of births, it occurs as part of a more serious condition like spina bifida.

Know that having clubfoot is not a painful condition for your baby. Most of the time, clubfoot can be corrected while your child is a still a baby. Treatment should begin a week or two after birth. Correction methods vary from manual foot manipulation over time to surgically fixing the foot.

There is a high success rate for treating clubfoot. After correction, your child should be able to participate in a variety of physical activities and lead a normal life. Children who do not get treatment for clubfoot will not be able to walk normally. Their foot or feet will remain deformed.

Doctors are not sure what causes clubfoot. There is some evidence to suggest that there is a genetic link. This means it seems to run in families. Also, if you already have one child born with clubfoot, your next child has a greater risk of also having clubfoot.

There is also research to suggest clubfoot is more common in babies whose mothers smoked or used recreational drugs (street drugs) during pregnancy. This is especially true if there is already a family history of clubfoot. Plus, there could be a link between low amniotic fluid and clubfoot. Amniotic fluid is the liquid that surrounds a baby in the womb.

If you are pregnant and have a family history of clubfoot, you may want to meet with a genetic counselor. He or she will be able to tell you more about the chances that your baby will have clubfoot.

Clubfoot treatment

There are two primary ways to treat clubfoot. One way involves stretching to reshape the foot. The other involves surgery. Most cases of clubfoot can be successfully treated without surgery. For the majority of babies, stretching and reshaping the foot is the best treatment option. There are a few reliable techniques for treating clubfoot with stretching. The most widely used is called the

Ponseti method.

Treatment usually begins as soon as possible after birth, typically within the first week. This is the best and easiest time to reshape the foot. The Ponseti method With this method, stretching is used in combination with a cast. Your doctor (or orthopedic specialist) will stretch your baby’s foot toward the correct position and then place a cast on it to hold it there. Every week or so, the doctor will remove the cast, stretch the foot further toward the correct position, and re-cast it. This will continue until the foot is fully in the correct position (usually several months).

Sometimes, the doctor will also need to clip a portion of the Achilles tendon that connects your baby’s heel to his or her calf muscle. Doing so will allow the tendon to grow to a normal length. If this is required, the doctor will do the clipping before putting on your baby’s final cast.

Once the final cast is off, your baby will probably need to wear special shoes and possibly a brace. He or she won’t have to wear these things forever. It could be several months or even a few years. You’ll also need to continue doing stretching exercises with your baby.

Surgery

When clubfoot is severe, surgery is often the best option for your baby. The surgeon (usually an orthopedic surgeon) will work to lengthen the tendons in the foot and may also need to realign the bones and joints.

Following surgery, your baby will likely also wear a cast for a few months. Your doctor may also prescribe special shoes and a brace for your baby once the cast is removed.

In rare cases, clubfoot is not completely correctable. Most of the time, babies who had clubfoot and received treatment are able to lead active lives as they get older.

Living with clubfoot

If your child’s clubfoot is not treated, he or she will not be able to walk normally. It is sometimes possible to walk with clubfoot, but it is very difficult. Children who have clubfeet tend to walk on the sides of their feet. This can cause large callouses and chronic pain. As your child gets older, having clubfoot will mean having a less active lifestyle.

There are three types of clubfoot that your child can be diagnosed with:

Idiopathic Clubfoot

A true (idiopathic) clubfoot accounts for the vast majority of cases. This type is stiff or rigid, and very hard to manipulate.

Positional Clubfoot

The affected foot may be more flexible, with a condition known as positional clubfoot. This flexible type of club foot is caused by the baby's prenatal position in the uterus (often breech). Positional clubfoot can easily be positioned into a neutral (not curved) position by hand.

Syndrome Clubfoot

A third type is syndrome clubfoot—in which the condition is part of a larger syndrome. This type is usually more severe and difficult to treat, with less positive outcomes