Clubfoot is congenital deformity that causes the foot to rigidly turn inward and downward. Depending on the severity of the inward turning, bracing, casting, or surgical correction may be employed to correct foot position and restore flexibility.
Causes and Symptoms of Clubfoot
Clubfoot is a congenital deformity where the foot is rigidly turned inward and downward, and is misshapen like a club. It can range from mild and flexible to severe and rigid, and can affect one or both feet. In some cases, the calf muscle and affected foot may be slightly smaller than normal.
Occurring in about 1 in 1,000 babies, clubfoot is the most common deformity of the bones and joints in newborns. The cause of clubfoot is not exactly known, but it is most likely a genetic disorder and not caused by anything the parents did or did not do. For parents with a child who has clubfoot, the risk of having a second child with the condition increases to 1 in 30.
Clubfoot Conservative Treatment Options
Treatment of clubfoot typically starts shortly after birth, and consists of a series of manipulations followed by casting that slowly corrects the foot in a specific sequence. This treatment is also known as the Ponseti Method, named after the doctor who developed it. Most children with clubfoot will required at least 4 to 6 casts, followed by a heel cord release (Achilles tendotomy), to correct the deformity.
Manipulation and Casting
Prior to casting, the foot is gently manipulated, after which the castings are performed on a weekly basis. The cast is formed out of a “soft” material and may be removed the night before or the morning of the next appointment allowing the child to be bathed. During the casting, it is helpful if the baby is as relaxed as possible and the physician will often recommend feeding during the casting process. If you are breastfeeding, consider pumping and bringing in a bottle.
After 4 to 6 weeks of casting, the child’s foot is usually ready for the final stage of treatment — a heel cord release. This is a same day procedure performed in the hospital under general anesthesia. During the procedure, the Achilles tendon is cut to release tension and allow the foot to dorsiflex. If the Achilles tendon is not cut, the foot is often forced upward, which can cause the arch of the foot to break down. After the heel cord release, one final cast is applied and left on for 2 to 4 weeks. The infant’s heel cord typically heals very quickly, so the surgery will not cause any permanent weakness.
The bracing process is started after the final cast is removed. The surgeons at Children’s Orthopaedic preferred brace is the Mitchell shoes with a Ponseti Bar because of its high comfort level and ease of use. It is extremely important that the brace fits properly and is worn as directed. Studies have repeatedly shown that the success of treatment is directly related to compliance with brace wear.
The brace is worn full time (24 hours a day, except for bathing) for 3 months, after which it will be worn only at naps and night-time until the child is 3 years of age. Following full correction of the clubfoot, clinic visits will be scheduled every 3-6 months for 2 years, and then less frequently. Your physician will decide on the duration of bracing depending upon the severity of the clubfoot and the tendency of the deformity to relapse.
Clubfoot Surgical Treatment
Although the results are better if extensive bone and joint surgery can be avoided altogether, 5-10% of infants born with clubfeet have very severe deformities with stiff ligaments that are unyielding to the manipulation and casting. If all attempts to improve the deformity with the Ponseti Method have been unsuccessful, surgical correction is often required.
Recovery from Clubfoot Treatment
A child with a clubfoot, corrected by the Ponseti Method, can be expected to have a nearly normal foot. However, some minor differences may be noticed, such as the treated clubfoot being slightly smaller than the normal foot and a slight reduction in the size of the lower leg muscles. The amount of difference depends on the original severity of the clubfoot. In addition, a small but insignificant degree of shortening of the leg may be seen.
Children with clubfeet can participate in sports like anyone else. Famous athletes such as Mia Hamm (soccer), Kristi Yamaguchi (figure skating) and Troy Aikman (pro football) had clubfeet and have had very successful athletic careers.
Clubfoot in Tampa-St. Petersburg, Florida
With five board-certified pediatric surgeons specializing in orthopaedics and scoliosis, the Children’s Orthopaedic and Scoliosis Surgery Associates team provides the highest level of comprehensive care to patients in the Tampa, Florida area. The Children’s Orthopaedic and Scoliosis Surgery Associates specialize in providing state-of-the-art comprehensive care, both surgical and non-surgical, to patients suffering from congenital orthopaedic anomalies, such as clubfoot.