If your newborn is diagnosed with clubfoot, the news may sound scary. But there’s no need to panic. Clubfoot is one of the most common birth defects, and chances are very good your child will later walk (and run!) just like other kids thanks to the very effective treatment methods out there.
Here's what you should know about this condition so you can get your baby the care he needs.
What is clubfoot?
Clubfoot is a condition in which a child’s foot points downward and twists inward. The foot can sometimes look like the head of a golf club, giving the condition its name.
Affecting about 1 in 1,000 babies in the U.S., clubfoot is one of the most common birth defects, and boys are twice as likely as girls to have it.
Clubfoot can be mild or severe, and it can develop in one foot or two. In about half of babies with clubfoot, both feet are affected.
Symptoms of clubfoot
Your pediatrician will most likely diagnose the condition at birth, or sometimes, it’s picked up during a fetal ultrasound. Signs include:
- A foot turned inward
- A deep crease on the bottom of the foot
- A slightly shorter foot or leg
- A thinner calf due to underdeveloped muscles
Fortunately, clubfoot isn’t painful at first, and early interventions usually prove successful. But if clubfoot is left untreated, it can lead to chronic pain and trouble walking.
What causes clubfoot?
It’s not known for sure, but clubfoot may stem from a mix of genetic and environmental factors. Risk factors include:
- A family history of clubfoot. If an older brother or sister has clubfoot, there’s a slightly higher chance that the younger sibling will have it as well.
- Smoking during pregnancy. Lighting up during pregnancy raises the risk of a number of conditions, including clubfoot.
- Being male. Boys are twice as likely as girls to develop clubfoot.
- Having a genetic syndrome, like Edwards syndrome (trisomy 18).
- Having a neuromuscular disorder, such as cerebral palsy or spina bifida.
- Oligohydramnios, or low amniotic fluid during pregnancy.
- Breech birth, or being born bottom first.
Babies born with clubfoot also have an increased risk of developmental dysplasia of the hip (DDH), a condition where the top of the thigh bone slips in and out of its socket.
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Types of clubfoot
There are two main types of clubfoot:
Idiopathic clubfoot
This is the most common form of clubfoot and occurs in children with no other medical problems. Babies with idiopathic clubfoot have feet that are stiff and hard to manipulate.
Syndromic clubfoot
This type of clubfoot is part of a larger syndrome like spina bifida. It’s usually more severe and harder to treat. It may also require multiple or more extensive surgeries to correct.
Regardless of the type, it’s important to know that clubfoot will not improve on its own without treatment.
Treatment for clubfoot
While it can be worrisome to learn that your baby has clubfoot, the good news is that treatment for clubfoot is highly successful, especially when therapy starts right after birth. As a newborn, your little one’s bones, joints and tendons are extremely flexible, making the condition easier to treat.
The goal is for your child to to stand and walk without pain with the sole of his foot flat on the ground. Over the past two decades, doctors have had more success correcting clubfoot without surgery, making the foot functional and strong by the time a child is ready to stand and walk.
Ponseti method
This is the most widely used clubfoot treatment and uses gentle stretching and casting. A doctor stretches your baby’s foot into the correct position and then casts the leg from the foot to the thigh, repositioning and casting the foot every week for six to eight weeks.
About 90 percent of babies will then need an Achilles tenotomy, a minor procedure where an orthopedic surgeon uses a very thin instrument to cut the Achilles tendon. A new cast is applied to the leg until it heals. Once it’s removed about three weeks later, the Achilles tendon will have regrown to the right length.
After the foot is in the proper position, your little one will wear a brace for three to four years. For the first three months, he'll need to wear the brace essentially full-time. Then, he’ll need to wear it about 12 to 14 hours a day (at naptime and overnight).
It’s important for your child to wear the brace as your doctor directs. Otherwise, the foot will return to its original position.
French functional method
There's another type of nonsurgical treatment called the French functional method. A physical therapist manipulates your newborn’s foot and then tapes it into position until the next day’s manipulation. (Most babies go to a physical therapist three times a week, and the parents also learn how to do this at home.)
After three months, these visits can taper off, although parents will have to continue stretching, taping and splinting every day until the child is 2 to 3 years old. Many of these babies also require an Achilles tenotomy as well.
Surgery
While many cases of clubfoot respond to nonsurgical treatments, sometimes it’s not enough, or the condition returns. When that happens, an orthopedic surgeon can surgically lengthen tendons and adjust the joints in the foot and ankle. After surgery, a child will need to wear a brace or special shoes for about a year.
Prognosis for clubfoot
Children who get treated for clubfoot usually have a nearly normal foot. The affected foot may measure about a size smaller than the other foot, and the calf muscles may also stay smaller. This isn’t usually a problem, although they may notice some muscle soreness and fatigue sooner if they exercise very hard.
The good news: After treatment, your child will be able to wear ordinary shoes, run and play sports — just like any other kid.
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