Clubfoot is one of the most common birth defects. It affects one or two in every 1,000 babies born. If your child has clubfoot, don’t stress — it is a relatively easy congenital condition to treat.
What Causes Clubfoot?
In many cases, we don’t really know what causes the problem; this is called idiopathic clubfoot. In other cases, causes include:
Genetics. Clubfoot may “run in the family” — a grandparent, parent, cousin or other relative may have had it as a child. This makes your child more likely to have clubfoot, but not all people with a family history of the condition have kids with clubfoot.
Environmental causes. It seems that women who smoke or drink alcohol during their pregnancy are more likely to have a child with clubfoot. It may be that the smoke or alcohol triggers a genetic risk that leads to clubfoot, or it could be that these activities themselves affect other things during the baby’s development that lead to clubfoot.
Neuromuscular disorders. Some cases of clubfoot are caused by a miscommunication between the brain and the muscles. This results in the muscles and tendons of the foot being very tight, which can pull it into a shape that looks like clubfoot. This may sometimes be called extrinsic clubfoot, rather than intrinsic clubfoot. It is sometimes seen in children with cerebral palsy, myelomeningocele, arthrogryposis, spina bifida and other conditions.
During development, a baby may develop positional clubfoot. It can happen when a baby is cramped or in an awkward position during the pregnancy. This is temporary and is not true clubfoot. After stretching and rotating the foot, it often returns to normal shape.
Diagnosis and Symptoms of Clubfoot: What Does It Look Like?
In some cases, clubfoot is first found on a prenatal ultrasound. However, most cases are noticed at birth.
Clubfoot can be diagnosed by an orthopedic specialist through a physical exam. You can expect the doctor to rotate, massage, stretch and flex the foot of your baby to see whether it loosens the muscles and tendons. If the foot regains its range of motion and a more normal shape, the problem was probably due to being cramped during pregnancy. If the foot still does not relax or flex well, however, clubfoot may be diagnosed.
These are the key signs of clubfoot:
Toes or middle of the foot curve inward
Whole foot curves like a kidney bean
Heel is tilted inward and down
Treatments for Clubfoot
Clubfoot treatment will depend on a child’s age and the severity of their foot deformity.
In most cases, clubfoot may require five to seven casts, plus one small procedure to fully correct, often done in the office. People with very stiff feet may require even more casting and additional surgeries. The treatment process starts with one cast per week. The casting is not painful. The final cast may be on for about three weeks.
About nine in every 10 children with clubfoot also require a minor, in-office surgery called a percutaneous Achilles tenotomy. The orthopedic surgeon clips the Achilles tendon and then puts on a cast. This helps get the foot into the proper position so that the new tendon won’t be as tight. The tendon grows back quickly in children under 2 years of age.
After casts and any surgeries are done, kids have to wear “boots and bars” — a set of strap-on boots attached to each other by a bar underfoot — 23 hours a day for about three months. Then they can cut back to wearing them just during naps and at night until about 4 years of age.
When treated early, most kids with clubfoot (about eight in every 10) have a total correction in the deformity. They can lead active, athletic lives and do not have any pain or mobility problems down the line.
However, it’s not uncommon for people to have some recurrence, foot pain or rotation problems as older children or adults. This is especially common when the boots and bars weren’t worn enough or when the clubfoot was severe or related to a neuromuscular condition. In any case of recurrence, you should absolutely see an orthopedic specialist to get evaluated. Many times, additional casting, physical therapy or surgery can help relieve symptoms.
The Final Scoop on Clubfoot
Ideally, clubfoot should be treated starting at about one month of age. But no matter how old, anyone with symptoms of clubfoot — or pain or mobility problems after previously treated clubfoot — should see an orthopedic specialist. It’s never too late to search for ways to improve the foot’s function and comfort!
For more information about the Orthopedic Center at Nationwide Children's Hospital click here, or listen to our Pediacast.
Amanda T. Whitaker, MD, is a faculty member of the department of orthopaedic surgery and director of the Gait Lab.
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