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Clubfoot, also known as talipes equinovarus, is a congenital (present at birth) foot deformity. It affects the bones, muscles, tendons, and blood vessels and can affect one or both feet. The foot is usually short and broad in appearance and the heel points downward while the front half of the foot (forefoot) turns inward. The heel cord (Achilles tendon) is tight. The heel can appear narrow and the muscles in the calf are smaller compared to a normal lower leg.
Clubfoot occurs in approximately 1 in every 1,000 births, with boys slightly outnumbering girls. One or both feet may be affected.
Clubfoot is considered a "multifactorial trait." Multifactorial inheritance means there are many factors involved in causing a birth defect. The factors are usually both genetic and environmental.
Often one gender (either male or female) is affected more frequently than the other in multifactorial traits. There appears to be a different "threshold of expression," which means that one gender is more likely to show the problem than the other gender. For example, clubfoot is twice as common in males as it is in females. Once a baby has been born with clubfoot, the chance for it to happen again in a male or female child is about 4 percent overall. In other words, there is a 96 percent chance that another baby would not be born with clubfoot.
Risk factors may include the following:
Babies born with clubfoot may also be at increased risk of having an associated hip condition, known as developmental dysplasia of the hip (DDH). DDH is a condition of the hip joint in which the top of the thigh bone (femur) slips in and out of its socket because the socket is too shallow to keep the joint intact.
Your baby's physician makes the diagnosis of clubfoot at birth with a physical examination. During the examination, your baby's physician obtains a complete prenatal and birth history of the baby and asks if other family members are known to have clubfoot. If the diagnosis of clubfoot is made in an older infant or child, the physician will also ask about developmental milestones since clubfoot can be associated with other neuromuscular disorders. Developmental delays may require further medical follow up to evaluate for underlying problems.
Diagnostic procedures of the foot may include:
The affected foot may be flexible, known as a "positional clubfoot." This flexible type of clubfoot is caused by the baby's position in the uterus. Positional clubfoot can easily be positioned into a neutral (not curved) position by hand. A true clubfoot is stiff, or rigid, and very hard to manipulate.
The symptoms of clubfoot may resemble other medical conditions of the foot. Always consult your baby's physician for a diagnosis.
Specific treatment for clubfoot will be determined by your baby's physician based on:
The goal of treatment is to straighten the foot so that it can grow and develop normally. Treatment options for babies include:
According to the American Academy of Orthopaedic Surgeons (AAOS), the Ponseti method, which uses manipulation and casting, is the most frequently used method in the US to treat clubfoot. Most cases of clubfoot in infants can be corrected within 2 to 3 months using this method. It is recommended that Ponseti method treatment be started as soon as clubfoot has been diagnosed, even as soon as one week of age. The AAOS states that infants with clubfoot occasionally have a deformity severe enough that manipulation and casting will not be effective.
Because clubfoot may recur, braces are worn for several years to prevent relapse. Initially, the braces are worn for 23 hours a day for up to 3 months, then at night for 2 to 4 years.
Long leg casts are applied from the upper thigh to the foot. These casts are used for thigh, knee, or lower leg fractures. They can also be used with knee dislocations or after surgery on the leg or knee area.
A short leg cast is applied to the area below the knee to the foot. This type of leg cast is used for leg fractures and severe ankle sprains/strains or fractures. A short leg cast may also be used to hold the leg or foot muscles and tendon in place after surgery to allow healing.
Contact your physician if your baby develops one or more of the following symptoms:
Most babies with clubfoot can be corrected with serial manipulation and casting. Some babies may require surgery to help correct the position of the foot. Additional surgeries may be necessary since the deformity may come back as the child grows and develops.???