Clubfoot is a birth abnormality that causes the shape of a newborn baby’s feet to point down and inward. While clubfoot does not cause pain, it can cause long-term problems if left untreated, affecting the child’s ability to walk normally. However, if it is properly treated, the deformity can often be cured during the first few months of life.
The cause of clubfoot is not well understood, and it is not due to anything the mother did during pregnancy. The deformity occurs in 1-2 of every 1000 births.
A clubfoot occurs when the tendons on the inside and the back of the foot are too short. This pulls the foot into a position that causes the toes to point down and inward.
Clubfoot can be supple (flexible) or rigid. The rigid deformities are more commonly associated with other congenital malformations and can be more difficult to treat.
The treatment for clubfoot typically begins soon after the child is born. Sometimes treatment is started immediately, while the child is still in the hospital, or it can be started when a child is a few weeks old.
Treatment should begin in the first few weeks of life, but it is not an emergency. The advantage of waiting is that this gives parents a chance to bond with their newborn without casts in the way.
The timing of treatment should be based on the preference of the parents and the treating orthopedic surgeon.
Manipulation and Casting
The usual treatment of a clubfoot consists of the pediatric orthopedic surgeon manipulating the foot and casting it in the corrected position. Over the span of several months, the manipulation is gradually increased until the foot reaches a normal position. This manipulation technique, “The Ponseti Method,” is named after the doctor who popularized this treatment.
The position and timing of casting stretches and rotates the foot into a proper position. Approximately once a week, the casts are replaced in a process called serial casting. The casts slowly correct the position of the clubfoot.
In about one-half of cases, manipulation is sufficient to correct clubfoot. In some cases, a surgical procedure may be necessary. During surgery, the surgeon will release (loosen) the tight Achilles tendon to allow the foot to assume its normal position.
Once the casts are removed, the child will usually wear nighttime braces until about age two.
Next Steps in Treatment
In some cases, additional surgery is needed to correct the position of the clubfoot. Most often this is needed when the child has other developmental problems (such as arthrogryposis) or if the treatment is delayed for more than a few months after birth.
If a clubfoot deformity is not corrected, the child will develop an abnormal gait (walk abnormally). A child with a club foot will walk on the outside of the foot. This can cause the skin to break down and may lead to infections. Furthermore, abnormal gait may lead to joint wear and chronic arthritic symptoms.