Clubfoot

What is Clubfoot?

Clubfoot is a deformity of the foot which occurs at birth or during childhood. A child with clubfoot has abnormal posturing of the foot which causes him to turn the ankle inward and walk along the outside edge of the foot. The word ‘club’ is also used to describe the appearance of the foot.

The affected foot tends to be smaller than normal and may even be 1cm shorter than the other foot. In addition, some children with clubfoot have stiffness and a lack of mobility in some of the joints of the foot and small calf muscles. Clubfoot occurs 1 in 1000 births, equally in males and females. In half of the cases, both feet are affected. When this happens, one foot is usually affected more than the other.

Causes of Clubfoot

Clubfoot can be hereditary. There are two categories of clubfoot. The first and most severe type is associated with other congenital (or genetic) abnormalities or problems occurring when the fetus is inside the mother's uterus. These include neurogenic conditions (spinal dysraphism, tethered cord, arthrogyrposis), connective tissue disorders (Larsen's syndrome, diastrophic dwarfism), and mechanical conditions (oligohydramnios, or congenital constriction bands). The second type of clubfoot is less severe and is called "idiopathic" which means "of unknown cause." Treatment of children in this group tends to be more successful.

Treatment of Clubfoot

Treatment of clubfoot is most effective and rapid when it is administered shortly after birth. If treatment is delayed, the foot becomes more rigid within a few days. Straps and splints can be used for  newborns until a cast can be applied. Different casts are applied in a sequence to correct different areas of the foot. First the forefoot is corrected, then the inversion of the heel and finally the ankle. After the condition is fully corrected a night brace may be recommended for long term maintenance of the correction. Treatment requires patience and an experienced orthopedist. If treatment is not done correctly and in sequence, other deformities of the foot may occur.

About 50% of children with clubfoot eventually need surgery to lengthen the tightened structures of the foot. If the foot has already become rigid and resistant to cast treatment, corrective surgery is recommended.