Clubfoot: Causes, Symptoms, Diagnosis and Treatment

Clubfoot, also called talipes equinovarus, is a birth defect that affects the foot and ankle. It’s a congenital condition, which means that a baby is born with it. The foot or feet turn inward. When you look at the foot, the bottom of the foot often faces sideways or even up.

Clubfoot happens because of a problem with the tendons, the tissues that connect muscle to bone. The tendons in the baby’s leg and foot are shorter and tighter than they should be. That causes the foot to twist.

Extensive surgery used to be the main treatment to correct clubfoot. But today healthcare providers typically use a combination of nonsurgical methods and a minor procedure.

Clubfoot

What are the types of clubfoot?

There are two types of clubfoot:

Isolated or idiopathic clubfoot is the most common type. If your child has clubfoot with no other medical problems, it’s called isolated clubfoot. Idiopathic means that the cause of clubfoot is not known.
Nonisolated clubfoot happens along with other health problems. These conditions include arthrogryposis (a joint problem) and spina bifida (a neural tube disorder). Neural tube defects are problems of the brain, spine and spinal cord.

Who is at risk for congenital clubfoot?

Boys are up to twice as likely to develop clubfoot as girls are. Having a family history of clubfoot also puts the baby at higher risk.

Babies are also at higher risk if they have:

Another birth defect, such as spina bifida or cerebral palsy.
A genetic condition, such as Trisomy 18 (Edward syndrome).

A woman may be at higher risk for having a baby with clubfoot if she:

Had oligohydramnios during pregnancy. This is a problem of not having enough amniotic fluid, the fluid that surrounds the baby.
Had Zika infection during pregnancy, which can lead to birth defects and other problems.
Smoked, drank alcohol or used illegal drugs during pregnancy.

Does congenital clubfoot affect one or both feet?

About half of babies with clubfoot have a problem with both feet.

How does clubfoot affect my baby?

Clubfoot isn’t painful for your baby. Many babies won’t even notice it during the first few months of life. But clubfoot will get in the way of standing and walking. It won’t go away on its own. Babies with clubfoot need treatment to correct the problem before they reach walking age.

Untreated clubfoot can lead to:

Walking problems. Babies with clubfoot often walk in unusual ways. Typically, people walk on the bottoms and soles of their feet. A baby with clubfoot may walk on the sides and tops of the feet.
Foot infections.
Foot problems, including calluses. A callus is a thick layer of skin that often develops on the sole of the foot.
Arthritis, a joint condition that causes pain, stiffness and swelling.

How common is clubfoot?

Clubfoot is one of the more common problems children are born with. Around 1 in every 1,000 babies is born with clubfoot.

What causes congenital clubfoot?

Researchers don’t know the exact cause of clubfoot. It’s most likely a combination of genetics and environment:

Genetics: Genes tell the body how to look, grow and function. A problem with one or more genes (which are passed down from parents to children) could result in clubfoot.
Environment: Drug use and smoking during pregnancy may raise the risk of having a baby with a birth defect such as clubfoot.

What are the symptoms of clubfoot?

The most common sign of clubfoot is one or both feet turning inward. The foot faces the opposite leg.

You may also notice that the foot has a:

Kidney shape.
Deep crease on the inside mid aspect of the foot.
Higher arch than normal (called cavus foot deformity).

When and how is clubfoot diagnosed?

Many times, a healthcare provider notices clubfoot when you’re having an ultrasound during pregnancy. A prenatal ultrasound shows pictures of your baby in the uterus (womb). If your provider diagnoses clubfoot during pregnancy, you can start planning for the treatment your child will need after birth.

Other times, your provider may diagnose clubfoot after the baby is born. They’ll usually notice it during one of the baby’s first physical exams. In some cases, your provider may recommend an X-ray to confirm the diagnosis.

When should clubfoot treatment start?

Healthcare providers recommend treating clubfoot as soon as possible. Early treatment helps the child avoid problems later. It’s best to begin treatment during the baby’s first two weeks of life.

Who treats clubfoot?

Your baby will likely need a team of providers to treat clubfoot, including a:

Pediatric orthopedist, specializing in bone and joint problems in children.
Orthopedic surgeon, who specializes in surgery for bones and joints.
Physical therapist to help the child build strength and move the foot.

How is clubfoot treated?

There are several methods for treating clubfoot. Your care team will discuss the options with you and figure out which works best for your child. Treatments include:

Ponseti method, which stretches and casts the leg to correct the curve.
French method, which stretches and splints the leg to correct the curve.
Bracing, using special shoes to keep the foot at the proper angle.
Surgery, which may be an option if other methods don’t work.

What is the Ponseti method for clubfoot treatment?

The Ponseti method is the most popular treatment method involving serial casting. It lasts about two to three months. Your care team will start this therapy within the first two weeks after birth.

An orthopedic surgeon performs this method. They will:

Stretch the foot toward the correct position.
Put the foot in a cast, which starts at the toes and goes all the way to the upper thigh.
Repeat this process every four to seven days with a new cast. Each time, the surgeon moves the foot a little closer to the correct position.

Before the final cast, the surgeon typically performs an Achilles tenotomy. They:

Cut the heel cord (the Achilles tendon) in a quick procedure. This tendon connects the heel to the calf muscles. The cut is small and won’t need stitches.
Put on a new cast as the tendon heals, which takes about three weeks.

The goal of this surgery is to allow the tendon to grow to a typical length. When the last cast comes off, the tendon has reached a regular length. As your baby recovers, they may need to:

Do stretching exercises so the feet stay in the correct position.
Wear special shoes or a foot brace for a few years.

What is the French method for clubfoot treatment?

This method is similar to the Ponseti method, but it uses splinting and taping instead of casting. A splint is a device that supports and protects bones.

A physical therapist performs this treatment. They’ll start the treatment soon after birth. This treatment needs to be done every day rather than once a week. But you don’t need to return to the physical therapist each time. The physical therapist sees your child a few times a week and teaches you how to do the splinting and taping at home.

How to do the French method to fix clubfoot:

Stretch the baby’s foot toward the correct position.
Hold the foot in place using tape and splints.
Repeat this process every day for two months.
Repeat the process less frequently until the baby is 3 months old. (The physical therapist will tell you how often to do it).

Babies who undergo the French method often need an Achilles tenotomy as well.

After three months, you’ll likely notice improvement in your baby’s foot. To maintain the correct foot position and prevent clubfoot from coming back, parents often need to continue the regimen until their child is 2 or 3 years old.

How does bracing treat clubfoot?

Your care team may recommend bracing after your baby has finished the Ponseti or French method. Even if those treatments worked, the foot can move back to the incorrect position. A brace keeps the foot at the correct angle, so it doesn’t move out of position. The brace is usually a pair of shoes with a metal bar connecting them. The brace is often called “boots and bar.” It’s important to:

Wear the brace every day for three months, then only at night or naps for typically four years.
Follow the instructions carefully. If a child doesn’t wear the braces when they’re supposed to, the foot may return to the clubfoot position again.

There are several types of braces. Your provider will discuss the options with you so you can find the right brace for your child.

How does surgery treat clubfoot?

Sometimes, a child has severe clubfoot. Or you’ve tried nonsurgical methods, but they haven’t worked. Surgery can correct the problem. It’s best if your child has the surgery before they start walking. During the procedure, the surgeon:

Lengthens the heel cord and fixes other problems with the foot or feet.
Places pins in the foot to correct the position.
Puts a cast on the foot after the surgery.

A few weeks after the surgery, the surgeon:

Removes the cast and pins.
Puts a new cast on the child’s foot, which your child wears for about another four weeks.
Removes the final cast.

There’s still a chance the foot could return to the clubfoot position. Your provider may recommend bracing or special shoes to keep the foot in the correct position.

What are the risks of clubfoot surgery?

Risks of congenital clubfoot surgery include:

Nerve injury.
Infection.
Bleeding.
Stiffness.

How can I prevent clubfoot in my baby?

Good healthcare before and during pregnancy gives your child the best chance for a healthy start in life. Even before you’re pregnant, you may want to consider if a preconception checkup is right for you. During this visit, a healthcare provider makes sure you are as healthy as possible when you get pregnant.

If you are at high risk for having a baby with clubfoot or other birth defects, talk to a genetic counselor. A genetic counselor is an expert in birth defects and genetic conditions. And get checked for infections such as Zika virus. Treating infections before you become pregnant increases the chances for a healthy pregnancy and baby.

When you are pregnant:

Make sure to go to all your prenatal care checkups.
Protect against Zika.
Don’t smoke, use illegal drugs or drink alcohol.

What’s the outlook for babies with clubfoot?

Clubfoot does not go away on its own. Early treatment is essential for a positive outcome. Babies who start treatment early have good results. They can wear regular shoes, walk, run and play without pain. They can even play sports.

If only one foot was affected, you may notice that:

The affected foot is a smaller size and less mobile than the unaffected foot.
The calf muscles in the leg with the clubfoot may be smaller.
Your child may get tired or complain about sore legs sooner than children without clubfoot.
The affected leg may be slightly shorter. But this usually doesn’t cause major problems.

If your child has another condition along with clubfoot, the outlook may depend on treatment for the other condition.

Can clubfoot return?

Clubfoot can come back. It’s more likely to happen if the treatment schedule wasn’t followed exactly. If the foot returns to the clubfoot position, see your healthcare provider. They can advise you on the next steps. You may need to repeat some stages of the treatment plan.

How can I help my child with their brace?

Regularly wearing the brace gives your child the best chances for success. But it can be challenging for children to wear the brace for so many hours a day. These tips can help parents ease the process of brace wearing:

Make it fun: Play with your child when they’re wearing their brace. Do gentle exercises and kicking games. Use the bar to help bend and straighten their knees.
Make it routine: After the first three months, your child will only need the brace during nighttime and naps. Make the brace part of their sleeping routine. They’ll understand that going to sleep means wearing the brace.
Add a pad: A soft pad on the metal bar makes the brace more comfortable for your child and yourself. It also has the benefit of protecting furniture and appliances in your house.
Avoid lotion: Creams or lotions can make skin problems worse. It’s normal if your child’s foot has some redness on it. But blisters may mean the heel is slipping out of the brace. Makes sure to firmly strap on the shoes, so the foot doesn’t slip. And check your child’s foot frequently to make sure blisters aren’t forming.
Prevent slippage: Sometimes, the foot keeps slipping out of the brace. Make sure the strap is tight. Double socks may also help keep the shoe firmly on the foot. A physical therapist can recommend other steps to make sure the shoe is snug on the foot.

What else should I ask my healthcare provider about clubfoot?

Ask your provider for a referral to an orthopedic surgeon who specializes in the Ponseti method. This treatment requires a high level of skill and expertise. If your care team recommended the French method, get a referral for a physical therapist who specializes in that method.

Other questions for your provider if your baby has clubfoot:

When should my baby start treatment?
What is the best treatment method for my baby’s clubfoot?
How long will treatment last?
Will my child walk normally?
How can I prevent clubfoot from returning?