Clubfoot

What is Clubfoot?

Clubfoot refers to a foot deformity that a physician will diagnose at birth, or in some instances, by prenatal ultrasound. Clubfoot can be corrected soon after birth and with proper treatment, the foot can look and function normally.

Most children born with clubfoot have no other congenital problems. When clubfoot occurs without other problems, it is referred to as idiopathic (unknown cause). Clubfoot may be associated with a chromosomal abnormality, as a part of a syndrome (collection of other birth defects), or neuromuscular disorder that secondarily disrupts the structure of the foot. Medical examinations by your doctor or blood tests should be able to determine whether your baby’s clubfoot is idiopathic.

Although clubfoot can be mild or severe, all cases require a proper medical evaluation. Clubfoot will not resolve on its own. The clubfoot is not painful to the infant who does not yet walk. However, if left untreated, a child may develop painful calluses, may be unable to wear shoes and may experience lifelong painful feet limiting activity.

How Often Does Clubfoot Occur?

About one baby in 1,000 in the United States is born with clubfoot. The occurrence does vary with ethnicity. People of Chinese descent have the lowest occurrence, with 0.39 cases per 1,000 live births, whereas Polynesians have the highest occurrence at 6.5 to 7 per 1,000 live births. The ratio of clubfoot among males to females is 2:1 across ethnic groups. Both feet are affected in 50 percent of clubfeet cases, and when one side is affected, the right side is more frequently involved than the left.

What Causes Clubfoot?

Though the cause of clubfoot is still unknown, a genetic basis is likely. Other theories include:

  • Abnormal stunting of foot development prior to birth.
  • Abnormality of nerves, vessels or muscles in the leg and foot that causes the abnormal development.
  • Exposure to unknown environmental chemicals or medications.
  • Unfortunately, there currently is no method of preventing clubfoot. It is unlikely that anything during pregnancy caused the foot deformity.

Treatment

The goal of treatment is to straighten the foot so that it can grow and develop normally. Options include:

  • Nonsurgical treatments. The most common nonsurgical treatment in the U.S. is the Ponseti method, which consists of gentle stretching of the clubfoot followed by a long-leg plaster cast. The cast is removed and a new one is reapplied every one or two weeks. On average, five casts are required to correct the clubfoot, taking approximately two to three months.
  •  Other nonsurgical correction methods include taping, physical therapy, and splinting.
  • Braces. Even when well corrected, clubfoot has a tendency to relapse until about the age of four. If braces are worn as prescribed, there is a 95% chance no other treatment will be necessary. Use of the brace will not cause developmental delays: children will still learn to crawl and walk even in the brace. At first, braces are worn for 23 hours each day for up to three months. Then they are worn at night for two to four years.
  • Surgery. Your child may need surgery if other treatments don't fix clubfoot. The specific surgery depends on the type and extent of the deformity. Your child may need surgical wires, pins, or a cast to keep the foot in place until it has healed.

What is Involved with Follow-up Care?

Regular clinic visits are important after surgery. During the bracing years, your child will visit us every three months for a clinical examination and to ensure that a brace is fitting well. Approximately every six months, your child will outgrow a brace and require a new one. Periodically, an X-ray of your child’s feet and legs will be done to ensure good correction is maintained.

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