Clubfoot is a condition where one or sometimes both foot of the newborn are twisted inward, resembling a golf club. This can be alarming for parents.

Around 1 in 1,000 babies worldwide are affected by it. When parents learn their child has clubfoot, they could feel anxious, confused, or dreadful. What led to it? Will the child be able to walk normally? Will they need surgery? These are typical worries.

If left untreated, clubfoot can result in permanent disability; however, outcomes can be significantly enhanced with early diagnosis, prompt intervention, and care.

In this detailed blog post, we will explore everything you need to know about clubfoot, from what it is and how it happens to the different treatment options available, including surgical intervention.

Clubfoot: What is it?

Clubfoot, sometimes referred to medically as Congenital Talipes Equinovarus (CTEV), is a deformity of the foot where it is twisted inward and downward at birth.

It usually affects one or both feet, and in some cases, the severity of the condition can vary from mild to severe. The condition affects the bones, muscles, tendons, and blood vessels in the foot, resulting in an abnormal appearance and positioning.

The twist in the foot is not just cosmetic—without treatment, clubfoot can cause significant problems with walking, balance, and physical mobility. In addition to having limited ankle joint mobility and typically being smaller than a normal foot, the affected foot may also have a tight Achilles tendon.

How it Happens: The Mechanism

In a healthy foot, the muscles, tendons, and bones work together in unity, allowing for a normal range of motion. In clubfoot, however, the tendons (the tissues that connect muscles to bones) in the leg and foot are shorter and tighter than normal. This makes the foot to be pulled into an abnormal position, typically turning inward and downward.

While researchers are still studying the exact mechanisms that cause clubfoot, it’s generally believed to result from a combination of genetic and environmental factors. During fetal development, something goes wrong in the formation of the muscles, bones, or tendons of the foot, causing the condition.

Types

Clubfoot is often divided into two main categories:

Isolated (idiopathic) clubfoot: The most prevalent type of the malformation, , affects youngsters only when they don’t have any other health issues.

Non-isolated clubfoot: can coexist with a number of medical diseases or neuromuscular problems, including spina bifida and arthrogryposis. In the event that your child’s clubfoot is linked to a neuromuscular disorder, the clubfoot:

• Maybe more treatment-resistant
• Need a lengthier non-surgical therapy regimen
• May require several surgeries
  

Clubfoot, no matter what kind or severity, cannot get better on its own without medical attention. An untreated clubfoot in a child will:

• Instead of using the sole of their foot, they walk on the outer edge
• Grow uncomfortable calluses
• Be unable to wear shoes
  

Causes

Clubfoot can occur as an isolated condition or as part of a syndrome (a collection of signs and symptoms that go together) involving other congenital abnormalities. Several factors can increase the risk of a baby being born with clubfoot:

1. Genetics: There is a strong genetic component to clubfoot. If a parent or sibling has had clubfoot, the likelihood of another family member being born with it increases. Studies suggest that if one child in a family is born with clubfoot, there is a 2-6% chance of another child having the condition.
   
   
2. Environmental Factors: While the exact causes are not fully understood, certain environmental factors may contribute to the development of clubfoot. These may include inadequate room for fetal movement during pregnancy, such as when there is low amniotic fluid, or maternal smoking during pregnancy, which has been linked to an increased risk.
   
   
3. Neurological Conditions: Clubfoot can sometimes be associated with other congenital abnormalities or neuromuscular conditions, such as spina bifida or cerebral palsy. In these cases, the foot deformity is secondary to the underlying neurological condition.
   
   
4. Syndromic Clubfoot: In some cases, clubfoot occurs as part of a broader syndrome, such as Ehlers-Danlos syndrome or Trisomy 18. These syndromes often come with multiple health issues, and clubfoot is just one of the symptoms.
   

Diagnosis

Clubfoot is typically diagnosed through physical examination and prenatal ultrasounds. Here’s how the diagnosis process typically works:

1. Prenatal Ultrasound: In some cases, clubfoot can be detected during a routine ultrasound between the 18th and 22nd weeks of pregnancy. If the ultrasound shows an abnormal foot position, further monitoring may be recommended.
   
   
2. Physical Examination at Birth: Most often, clubfoot is diagnosed at birth through a simple physical exam. A doctor will look for the characteristic inward twist of the foot and assess the foot’s flexibility.
   
   
3. X-Rays or Imaging: In severe cases, especially when considering surgical options, X-rays or other imaging studies may be done to evaluate the severity of the condition and assess the bone structure of the foot.
   

It’s important to diagnose clubfoot early because the sooner treatment begins, the better the outcomes.

Management

The primary goal of treating clubfoot is to correct the deformity and ensure the child can walk, run, and move normally. Treatment usually begins shortly after birth, and while non-surgical methods are preferred in most cases, surgery may be necessary for more severe deformities. Here’s a breakdown of the treatment options:

Non-Surgical Treatment: The Ponseti Method

The Ponseti method is the gold standard for treating clubfoot and has a success rate of about 90%. This method involves:

1. Gentle Manipulation: The doctor will gently stretch and manipulate the baby’s foot into a more normal position.
   
   
2. Casting: After each manipulation, the foot is placed in a cast to hold the new position. This process is repeated weekly for about 6-8 weeks.
   
   
3. Achilles Tendon Release: In many cases, the Achilles tendon (at the back of the ankle) is too tight. A minor procedure, called a tenotomy, may be performed to lengthen the tendon. This is usually done under local anesthesia, A cast is applied for 3 weeks to allow the tendon to heal and regrow.
   
   
4. Bracing: After correction, the foot may naturally tend to revert to its abnormal position. To prevent recurrence, the baby wears a brace (often called “boots and bar”) for 3-4 years, initially for 23 hours a day, then gradually less over time. The brace helps maintain the foot’s correct position.
   A review in the European Journal of Orthopaedic Surgery & Traumatology highlights the success of this method, particularly in hospital settings where regular follow-up ensures effective correction​.
   
   
   This bracing process can be challenging, but it’s crucial to ensure long-term correction of the clubfoot. Different types of braces are available, and babies may need time to adjust to wearing them.
   

Surgical Treatment

In some cases, non-surgical methods like the Ponseti method may not fully correct the foot, or the condition may relapse over time. In these situations, surgery is often recommended to correct the deformity.

Indications for Surgery:

• Severe clubfoot that does not respond to the Ponseti method
• Recurrent clubfoot after initial correction
• Syndromic clubfoot or when clubfoot is part of a larger congenital condition
  

Procedures

Surgical correction of clubfoot aims to adjust the tendons, ligaments, and bones to bring the foot into a normal position. Here’s what you can expect during the surgical process:

1. Lengthening the Achilles Tendon: As with the Ponseti method, the Achilles tendon may be too tight. In surgery, the tendon is lengthened to allow for more flexibility in the ankle joint.
   
   
2. Tendon Transfer: The surgeon may need to transfer tendons from one part of the foot to another to achieve a better alignment. This helps balance the forces on the foot and prevents the deformity from recurring.
   
   
3. Joint Realignment: In severe cases, bones in the foot may need to be repositioned or fused to correct the abnormal shape of the foot.
   
   
4. Internal Fixation: During surgery, metal pins or screws may be used to hold the bones and joints in the correct position while they heal.
   
   
5. Post-Surgical Casting and Bracing: After surgery, the child will need to wear a cast to allow the foot to heal in its new position. Bracing may also be necessary to maintain the correction over time.
   

Recovery and Outcomes

Surgical recovery typically takes several weeks, during which the child will need to wear a cast. After the cast is removed, the child will often require physical therapy to help regain strength and mobility in the foot. Bracing may also be needed for a year or more to prevent the foot from returning to its pre-surgery position.

Surgical treatment is generally very effective, although it comes with risks like any surgery, including infection, scarring, and the potential for the deformity to recur. However, in most cases, surgery significantly improves foot function, allowing the child to walk and run normally.

Helpful Tips

Make Playtime Fun in the Brace

Engaging your child in play while they wear the brace can help ease irritability. If the brace uses a solid bar, encourage them to kick and swing their legs together. You can assist by gently pushing and pulling the bar to bend and straighten their knees. With a dynamic bar, moving their legs up and down helps them get used to the brace more comfortably.

Establish a Routine

Children adapt better when the bracewear becomes a part of their daily routine. Use the brace consistently during naps and nighttime. When your child associates the brace with sleep time, they are less likely to resist or fuss, making it easier for both you and them.

Pad the Brace Bar

To protect your child, yourself, and your furniture from the hard metal bar, consider using a bicycle handlebar pad to cushion it. This will prevent accidental bumps and make the brace more comfortable for everyday use.

Avoid Using Lotions

Never apply lotion to your child’s skin before putting on the brace. Lotion can worsen skin irritation. Some redness is normal, but bright red spots or blisters may indicate the heel is slipping inside the shoe. Secure the straps and check the feet regularly to ensure the heel stays in place and no blisters are forming.

Prevent Escapes from the Brace

If your child keeps slipping out of the brace, here are some tips to keep the foot secure:

• Tighten the strap or buckle by one more notch while holding the foot in place with your thumb.
  
• Use double socks—one on the foot and one on the removable insert (if applicable) to fill extra space.
  
• Lace the shoes from top to bottom, so the bow ends up by the toes.
  
• Experiment with different sock thicknesses, or try non-slip socks to keep the foot from sliding inside the shoe.
  

Following these tips will help ensure your child adjusts comfortably and safely to their bracewear routine.

Conclusion

Clubfoot may seem daunting, but with early diagnosis and proper treatment—whether through non-surgical methods like the Ponseti technique or surgery—the prognosis is generally good. Most children with clubfoot grow up to walk, run, and lead normal lives.

For parents facing the challenge of clubfoot, early intervention is crucial. Whether the path involves gentle manipulation and casting or requires surgical correction, modern medical approaches have significantly improved the outcomes for children born with this condition.