Clubfoot

What is clubfoot?

Clubfoot is the name given to an abnormality affecting the foot, which is usually present from birth (congenital).  The tendons which connect the muscles in the foot to the bone are shorter in someone with clubfoot, and this causes the foot to twist and turn in. As a result the individual bones in the foot will change in shape and alignment. As a result, the individual bones in the foot will change in shape and alignment.

It’s a relatively common problem, affecting an average of one to two children in every 1,000 live births .Although it usually is an isolated issue for most healthy babies it can be associated to a wide range of underlying conditions. The development of clubfoot begins in the first trimester of pregnancy, so by the time a baby is born the foot can be quite stiff. Fifty percent of children affected by clubfoot will have it in both feet.

Common signs and symptoms of clubfoot

Whilst it can range in severity, clubfoot is usually a painless condition with symptoms such as:

  • Shortening of the affected foot and leg
  • Inward turning and twisting of the foot which increases the arch of the foot and causes the heel to face inwards
  • Underdevelopment of calf muscles
  • The appearance of the foot being upside down (in extreme cases)
  • Restricted movement of the foot
  • Mild difference in leg-length

If left untreated, clubfoot can become cripplingly painful and result in severe disability.

Common causes of clubfoot

The exact cause still remains unknown. When a baby is developing in the womb, the tendons at the back and the front of the foot fail to grow at the same pace of the rest of the foot, it creates the shortening which causes deformity twisting the foot inwards and down. Even though the reasons as to why this happens are largely unknown, there are some risk factors related to this condition, including:

  • Being male – the condition is more common in boys but girls can be affected too
  • Being born with other medical conditions such as spina bifida or a joint condition called arthrogryposis
  • A family history of clubfoot
  • Association with higher occurrence in smoking mothers

Clubfoot is not caused by the position of the baby when inside the womb.

Diagnosing clubfoot

Clubfoot is usually noticed at birth by a healthcare professional. In some cases it is detected before birth during routine scans. It is generally diagnosed based on appearance and physical examination.

Treating clubfoot

It is important that clubfoot is appropriately treated, because without intervention, it can cause bone deformities to occur as the child grows. Aside from being unsightly, an untreated club foot can cause:

  • Problems with walking- an adult may become crippled as the deformity in the foot worsens
  • Skin ulceration – due to weight bearing on the outside of the foot
  • Infection – from repeated skin ulceration

Treatment should ideally be started 2 weeks after birth using the Ponseti technique for clubfoot correction

Manipulation and foot casting

Your doctor will begin treatment by manipulating the foot into the closest position to normal as possible and then fixing it in place and applying a cast. Each week, the cast is taken off and the foot manipulated further before the new cast is applied.  On average the foot can be corrected with 4-6 casts.  Before the last cast it is often necessary to lengthen the Achilles tendon to achieve a plantigrade foot. This small procedure is done in the out-patient clinic, the last cast remains in place for 3 weeks.

Special shoes and braces

Once the last cast is removed the child moves on to the bracing protocol of the Ponseti technique. For the first three months the foot abduction bar and shoes are worn 23 hours per day, after this period brace wearing reduces to 14 hours per day. The brace and shoes need to be worn until the child is 4 or 5 years old to prevent recurrence of the deformity. It is necessary to follow up with your Orthopaedic Surgeon  every 3 to 6 months to check brace compliance and to look out for any signs of recurrence. The most common reason for recurrences is non compliance with the brace, reported up to 60 percent in children not adhering to the bracing protocol. Compliant children have a relapse rate of approximately 15%.

If the Ponseti method is followed 95% of children will have their clubfoot fully corrected without the need for surgery. The child will have a largely normal looking, shoe-able and well-functioning foot.

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