CLUBFOOT

Clubfoot

According to the National Institute of Health (NIH), more than 1 in every 1000 children have clubfoot when they are born. The condition occurs twice as common in boys. Idiopathic clubfoot (also known as Talipes Equinovarus) has no known cause. A child with clubfoot may find it difficult to move his or her foot.  Therefore, parents should seek timely medical help to prevent complications.

Parents of children with clubfoot may become anxious about their children’s condition. However, the prognosis of infants with this condition is terrific and the child will use their foot without any serious difficulty if doctors provide the appropriate treatment.

The medical team at Medical City Children’s Orthopedics & Spine Specialists has expertise in complex surgeries like clubfoot. The hospital often calls our doctors to notify them of potential club foot babies while they are still in utero. Therefore, if we need to operate, we can schedule and start treatment on babies as young as two days old.

Clubfoot Definition

Clubfoot, a common foot abnormality involving the foot and lower leg, can affect one or both feet. It’s a general term used to describe a range of unusual positions of the foot. Note, that there are twice as many males as females with this condition.

A Clubfoot does not cause pain in a baby, but it can eventually cause discomfort and become a noticeable disability for standing and walking. Therefore, a doctor should immediately begin treatment for this condition as Clubfoot will not go away without proper treatment. An affected foot will appear twisted with one leg appearing shorter and smaller than the other. These symptoms become more obvious and more of a problem as the child grows. Even buying shoes that fit gets hard. Treatment that begins shortly after birth can help overcome these problems.

Early Detection

Doctors can discover a baby’s Clubfoot while it develops in the womb due to the advancements in ultrasound technology. Women usually get an ultrasound procedure during their pregnancies, and in the 20th-week testing, doctors can usually see if a clubfoot deformity exists on the images. Therefore, with the aid of new and better imaging, doctors routinely diagnose clubfoot before birth. However, treatment of clubfoot cannot occur before the birth of the baby.

Clubfoot can occur on one foot or both feet. In almost half of affected infants, Clubfoot exists in both feet. Even though a baby does not experience pain with Clubfoot, treatment should begin immediately after birth. Club foot can cause significant problems as the child grows. But with early treatment, most children born with clubfoot lead a normal life.

What Causes Clubfoot?

In some cases, clubfoot results from the position of the baby while developing in the mother’s womb (postural clubfoot). But more often, clubfoot’s genesis relates to a combination of genetic and environmental factors that remain unclear. If someone in your family has clubfoot, then offspring are more likely to get the condition. Then, if your family has one child with clubfoot, the chances of a second infant having the condition increases.

When a doctor diagnoses Clubfoot, the doctor will look for additional health problems because children with clubfoot can also possess other medical conditions, such as spina bifida, Hip dysplasia, arthrogryposis, or myotonic dystrophy. For this reason, as soon as a doctor diagnoses clubfoot, the infant should get evaluated by a Pediatric Orthopedic doctor as well. Clubfoot can also result from problems that affect the nerve, muscle, and bone systems.

What Are The Symptoms of Clubfoot?

The tendons in a clubfoot are shortened. Also, the bones are distorted and the Achilles tendon appears tightened.

If the child does not get treated, the child may walk on his or her ankles or the sides of the feet.

The following are the symptoms of clubfoot in children:

• A stiff rigid foot of varying degrees.
• The foot (especially the heel) usually appears smaller than normal and turned in.
• Short and/or tight heel cord and the foot may point downward.
• The front of the foot may point toward the other foot.
• The foot may turn in, and in extreme cases, the bottom of the foot can point up.
• Deep heel crease; soft heel pad and overall wide front foot and smaller foot.

A medical care professional usually notices if a child has a clubfoot at birth.  In some cases, it can become detected before birth.

Most children with clubfoot have no other complications, while in some cases a clubfoot can have other conditions, like spina bifida.

Clubfoot Diagnosis

As mentioned earlier, ultrasound can detect clubfoot, although the severity of the condition must occur after the birth of the baby. Normally, doctors diagnose the condition after birth, based on the appearance and mobility of the feet and legs. In some cases, especially if the clubfoot is due to the position of the growing baby (postural clubfoot), the foot is flexible and moves into a normal or nearly normal position after birth. In other cases, the doctors report a rigid or stiff foot, and the muscles in the back of the calf are very tight.

Normally, doctors discover the condition at birth or at their initial evaluation after birth. An X-ray does not usually confirm the condition in a baby’s foot because ankle bones are not fully ossified (filled in with bony material) yet and do not show well on X-ray.

Clubfoot Treatment

Clubfoot runs in some families. If your child gets diagnosed with clubfoot, there are different treatment options that you can explore. The earlier you begin treatment, the better. Since a baby’s joints and bones are very flexible, doctors can easily manipulate them (to put the foot in the correct position) when treatment begins at an early stage.

Treatment for children with clubfoot starts soon after birth because the bones are mostly cartilage, and easily moldable. This early intervention will help your child have better mobility as he or she grows. The foot will grow strong and bear weight for standing and moving comfortably.

Nonsurgical Treatments

The Ponseti Method consists of a treatment phase and a maintenance phase. During the treatment phase, casting takes place. The doctor manipulates the foot (or feet) into the most normal position possible and held (immobilized) in that position until the next treatment. 

This manipulation and immobilization procedure happens every 1 to 2 weeks for 2 to 4 months, moving the foot a little closer toward a normal position each time.

In the maintenance phase, the last cast remains in place for approximately three weeks. Then a bracing or splinting is utilized to keep the foot (feet) in the proper position. Some children have enough improvement that the doctor will only implement splinting to keep the foot in the correct position as it grows.

The Surgical Treatment

The Percutaneous Transverse Achilles Lengthening (TAL) procedure is sometimes required if the heel cord is too tight to stretch it in a cast. During this procedure, your doctor will make a small cut through the tendon to help it stretch and lengthen, it normally takes about 15 minutes under general anesthesia in a hospital.

At the Medical City Children’s Orthopedics and Spine Specialists, we are experts in foot deformities. For this condition, we immediately begin casting. Toward the end of the series of castings, if the whole foot is pointing down, minor surgery to lengthen the tight Achilles tendon will take place. This is usually an outpatient procedure. This treatment works well if it is started right away and if the doctor’s instructions for bracing are followed after casting is finished. It helps at least 90 out of 100 children who have clubfoot.

If a few months of progressive manipulation and immobilization don’t move the foot into a more normal position, our doctors may suggest surgery. The most common surgical procedures are to lengthen or release the tight soft-tissue structures, including ligaments and tendons such as the heel cord (Achilles tendon), and to reposition the bones of the ankle as needed.

After Surgery

Small wires are often used to hold the bones in place and then are removed after 4 to 6 weeks. Splinting or casting usually occurs after surgery to keep the foot in the correct position during healing. After either nonsurgical or surgical treatment, splints are also used to keep the clubfoot from starting to form again. Your child should also have regular check-ups until he or she stops growing. If your child had surgery, he or she may also need physical therapy.

A mild recurrence of clubfoot can occur, even after successful treatment.  But after treatment, most children can wear shoes comfortably and walk, run, and play. If the child does not walk by the time he or she becomes 18 months old, you may need to see a specialist.

Complications of Clubfoot

Clubfoot makes the calf muscles appear smaller and less developed. If the affected foot is properly treated, it should not have any adverse effect on the child and he or she will play and run like the other kids.

However, if not treated, it can lead to long-term mobility problems. The child will not feel any discomfort or pain until he or she starts standing and tries to walk. This birth defect will make it difficult to walk on the soles of the feet.

Instead, the child will use the balls, the outer part, or (in severe cases) the top of the affected foot. The child is also at risk of developing arthritis. The inability of the child to walk properly can make him or her unable to participate in some activities. The strange appearance of the foot can also affect the child’s confidence.

Importance of Early Detection and Treatment of Clubfoot in Children

It is not difficult to detect clubfoot early in children because the doctor only needs to check the baby’s feet to know if he or she has clubfoot. As stated earlier, X-rays can also determine how severe the birth defect is.

A club foot condition often becomes detected while the baby is in the womb through ultrasound. Early detection of clubfoot helps parents explore the appropriate treatment options before the child is born.

Medical City Children’s Orthopedic and Spine Specialists Helps Children Stand on their Feet

At Medical City Children’s Orthopedic and Spine Specialists, our team of experienced and specialty-trained physicians, physical therapists, and cast technicians will provide successful Ponseti method treatment to ensure that your child makes the right progress to walk, run, and play like other children. The majority of children with clubfoot will undergo correction when in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts. After the correction, our specialists will provide the necessary instructions on how the child should wear a clubfoot brace so that the child can maintain the correction as he or she grows.

Clubfoot Bracing to Prevent a Relapse

Upon the doctor correcting a clubfoot, the child will need bracing to keep it corrected and prevent a relapse.  This really is an essential part of the treatment.  Please note that the doctor’s work will unravel if the child does not wear the bracing properly.

Therefore, the brace is critical for the success of the clubfoot treatment. If the brace does not get worn, a relapse is very likely.  If bracing is stopped at any point during the treatment, a relapse can occur at the following rates:

• 1st Year: 90%
• 2nd Year: 70 – 80%
• 3rd Year: 30 – 40%
• 4th Year: 10 – 15%
• 5th Year + : 5%

Clubfoot Brace Use

In children under walking age, the brace is worn 23 hours per day for 12 weeks. It is then worn at night and nap time until the child is 4 – 5 years old. A child must wear the brace as soon as the last cast is removed to avoid the foot turning back into its previous position