Clubfoot is a complex deformity that is readily apparent at birth and in some cases is diagnosed by prenatal ultrasound. The goal of treatment is to obtain and maintain correction of the clubfoot so that the patient has a functional, pain-free, plantigrade foot, with good mobility and without calluses, and does not need modified shoes. Parents of infants born with clubfeet and no other significant medical problems should be reassured that their child, when treated by medical experts, will have feet that are fully compatible with a normal, active life. However, it must always be remembered that a clubfoot will never be a normal foot.
Clubfoot is the most common congenital disorder of the legs. It can range from mild and flexible to severe and rigid.
The cause is not known, but the condition may be passed down through families in some cases. Risk factors include a family history of the disorder and being male. The condition occurs in about 1 out of every 1,000 live births.
The physical appearance of the foot may vary. One or both feet may be affected.
The foot turns inward and downward at birth, and is difficult to place in the correct position. The calf muscle and foot may be slightly smaller than normal.
Treatment should begin right away to have the best chance for a successful outcome without the need for surgery. Over the past 10 to 15 years, more and more success has been achieved in correcting clubfeet without the need for surgery. A particular method of stretching and casting, known as the Ponseti method, has been responsible for this. With this method, the doctor changes the cast every week for several weeks, always stretching the foot toward the correct position. The heel cord is then released followed by one more cast for three weeks.
Once the foot has been corrected, the infant must wear a brace at night for two years to maintain the correction. This has been extremely effective but requires the parents to actively participate in the daily care by applying the braces. Without the parents’ participation, the clubfoot will almost certainly recur. That’s because the muscles around the foot can pull it back into the abnormal position.
The goal of this, and any treatment program, is to make your newborn’s clubfoot (or feet) functional, painless and stable by the time he or she is ready to walk. (Note: Anytime your baby wears a cast, watch for changes in skin color or temperature that may indicate problems with circulation.)
On occasion, stretching, casting and bracing are not enough to correct your baby’s clubfoot. Surgery may be needed to adjust the tendons, ligaments and joints in the foot/ankle. Usually done at 9 to12 months of age, surgery corrects all of your baby’s clubfoot deformities at the same time. After surgery, a cast holds the clubfoot still while it heals. It’s still possible for the muscles in your child’s foot to try to return to the clubfoot position, and special shoes or braces will likely be used for up to a year or more after surgery. Surgery will likely result in a stiffer foot than nonsurgical treatment, particularly as the years pass by.
Without any treatment, your child’s clubfoot will result in severe functional disability. With treatment, your child should have a nearly normal foot. He or she can run and play without pain and wear normal shoes. The corrected clubfoot will still not be perfect, however. You should expect it to stay 1 to 1 1/2 sizes smaller and somewhat less mobile than the normal foot. The calf muscles in your child’s clubfoot leg will also stay smaller.