CLUBFOOT

Clubfoot Definition

Clubfoot (also called Talipes Equinovarus) is a common foot abnormality involving the foot and lower leg. This condition can affect one or both feet. Clubfoot is a general term used to describe a range of unusual positions of the foot. A clubfoot occurs in about 1 out of every 750 to 1,000 live births. And twice as often in males, 2:1 than females.

Clubfoot does not cause pain in a baby, but it can eventually cause discomfort and become a noticeable disability, including standing and walking. Therefore, a doctor should immediately begin treatment for this condition.  Clubfoot does not straighten itself out. An affected foot will appear twisted out of shape, and 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 will be problematic.  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 on 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 following characteristics of Clubfoot range from mild to severe:

• A stiff rigid foot of varying degrees.
• The foot (especially the heel) is usually 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.

Clubfoot diagnoses

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

Because this condition is usually present at birth, physicians look for it during their initial evaluation after birth. An X-ray does not usually confirm the condition in babies foot because ankle bones are not fully ossified (filled in with bony material) yet and do not show well on X-ray.

How is Clubfoot treated?

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 positioned to 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, or splinting are usually tried first. The foot (or feet) is moved (manipulated) into the most normal position possible and held (immobilized) in that position until the next treatment. This is usually done with a cast.

This manipulation and immobilization procedure is repeated 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 case 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 only further treatment is to keep the foot in the corrected position by splinting it 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 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 is usually used after surgery to keep the foot in the correct position during healing.

After either nonsurgical or surgical treatment, your child usually wears splints for a period of time 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 is common, even after successful treatment. Also, the affected foot will grow and be smaller (often 1½ shoe sizes or less), stiffer than the unaffected foot, and the calf of the leg will be smaller. But after treatment, most children are able to wear shoes comfortably and to 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.