What is Clubfoot?
Clubfoot can affect one or both feet. It is a congenital defect (meaning present at birth). It is a common defect that is often discovered and diagnosed in an otherwise healthy baby. The condition appears twice as often in boys than girls.
Clubfoot may be congenital, syndromic, or positional:
- Congenital clubfoot affects tendons, blood vessels, muscles, and bones in and around the affected foot. Because the tendons are shorter than normal, the baby’s foot position is rigid.
- Syndromic means that may be associated with another medical condition (such as spina bifida) that comes with other limb or genetic problems.
- Positional clubfoot is usually due to the baby’s position in the uterus (womb). Even though the baby’s foot is twisted, the foot is usually flexible and can be moved into a neutral position.
If clubfoot isn’t treated in childhood, it can cause walking and mobility problems later on. Typically, treatments that don’t require surgery will be tried first, even if the deformity is extreme. With treatment, your child may have slightly limited mobility, a smaller shoe size on the affected foot, and calf muscles that are smaller on the affected side.
Symptoms
Clubfoot may affect the foot, ankle, and leg in the following ways:
The foot may:
- Be twisted downward and inward. This increases the arch and turns the heel of the foot inward.
- Be twisted so severely that it appears upside down.
- Appear short and broad. It may be up to 1 inch shorter than the other foot.
- Calf muscles are often smaller and more undeveloped than in a normal leg.
- The Achilles tendon is tight and the heel may appear to be narrower.
Although clubfoot may look uncomfortable, it isn’t painful. It typically doesn’t cause any problems until a baby is ready to start standing up and walking and is not able to walk normally on the soles of the feet.
Causes
Clubfoot may be due to a genetic (inherited) condition, a developmental issue, or an environmental issue. Children with a family history of clubfoot are more likely to have it and it is twice as more likely to happen to boys than to girls. It can also be caused by:
- The position of the baby in the uterus
- A lack of amniotic fluid surrounding the baby in the uterus
- A pregnancy with multiple births (such as twins or triplets)
- A medical condition, such as cerebral palsy and spina bifida
Children with clubfoot are more likely to be born with dysplasia of the hip. This is when the hip socket is too shallow, so the top of the thigh bone slips in and out of the joint.
Diagnosis & Tests
- Your pregnancy
- Your family medical history
- If any other family members had clubfoot
X-rays of the baby’s foot may be needed to check for any additional problems. If clubfoot is not diagnosed until your child is older, your child’s doctor or healthcare provider will want to know about your child’s developmental milestones, since clubfoot can occur with nervous system disorders.
Treatments
Your child’s doctor will develop a treatment plan that fits your child’s needs. Treatment depends on the child’s age, health, symptoms, and severity of the clubfoot. The goal is to help the foot to grow properly so your child can get around normally. Treatment should be started as early as possible as it is easiest to reshape the position of your child’s foot early on. Treatments include:
- Stretching and casting. The orthopedic specialist moves your child’s foot into the correct position and then puts a cast on it to keep it in place. The cast is left on for about a week. The cast is taken off and the doctor gently stretches the foot again before putting on another cast. This may happen 5 to 10 times. The final cast will usually stay on for about 3 weeks. Once the foot is in the proper position, the child may need to continue to wear a brace at night for a few years to keep it in the right position.
- Stretching and splinting. This treatment is almost the same as stretching and casting, except that the doctor uses tape and a splint to hold the baby’s foot in the correct position.
- Surgery. Although most infants with clubfoot don’t need surgery, it may be recommended if the clubfoot is severe or if other methods don’t correct the clubfoot.
If not treated, clubfoot can cause problems later on, including:
- The inability to walk normally, since your child may have to walk on other parts of the foot because of the twisted ankle
- Problems from walking incorrectly, such as sores on the feet and underdeveloped calf muscles
- A high likelihood that the baby will develop arthritis
- Poor self-esteem as children notice differences and compare themselves to others
Prevention
Doctors don’t know whether clubfoot is due to genetics, environmental factors, or other causes, so you can’t prevent it. However, pregnant women can take some precautions to limit their baby’s risk of birth defects, including:
- Avoiding alcohol and any street drugs
- Avoiding any medicines that aren’t approved by your doctor
- Quitting smoking and avoiding secondhand smoke
- Eating healthy foods and getting regular exercise
- Taking folic acid (vitamin B6) to help prevent birth defects. Any woman who is in her childbearing years (ages 14 to 44) should take a multivitamin containing:
- 400 mcg (micrograms) before pregnancy
- 600 mcg daily during pregnancy
- 400 mcg of folic acid after your pregnancy (even if you are not intending to get pregnant again)