Why Some Infants Have Clubfoot

Clubfoot is a congenital condition, meaning it is present at birth. It causes a child’s foot to turn inward and downward. Clubfoot is the most common deformity of the leg and occurs in about 1 in 1,000 births. About half of children with the condition have bilateral clubfoot, meaning both feet are impacted.

Clubfoot can be treated about a week after birth. Moderate or mild clubfoot can usually be corrected without surgery, although some severe cases require an operation. Most children with clubfoot who are treated have a great prognosis and will be able to participate in normal activities, including sports once their club foot has been corrected. Still, it’s considered a serious condition since without treatment it can lead to lifelong disability, including trouble walking. 

Continue reading to learn more about clubfoot in infants and others, including the causes of clubfoot, its treatment, and its prognosis. 

What Causes Clubfoot?

Congenital clubfoot happens when the Achilles tendon—which connects calf and leg muscles to the heel bone—is too short. This causes the foot to point inward. Bones in the foot  become misaligned because of the pressure that muscles and tendons are putting on them.

Is Clubfoot Passed Down Through the Parents?

Researchers believe that clubfoot is caused by genetic and environmental factors. That means that the risk for clubfoot is greater if there is a history of clubfoot in the mother or father’s family. However, having a history doesn’t mean that a child will have clubfoot; and, club feet can also happen when there is no family history. 

Risk Factors for Congenital Clubfoot

Certain factors increase the incidence for clubfoot. For example, the condition is about twice as common in males than females. Other risk factors include:

• A family history of clubfoot: About 1 in 4 people with clubfoot have a family member with the condition. 
• Having another genetic health condition: About 1 in 5 people with clubfoot also have another health concern like trisomy 18, spina bifida, or muscular dystrophy. 
• Diabetes that develops in the pregnant parent: This is known as gestational diabetes. 
• Lifestyle of the pregnant parent: This includes smoking and drinking during pregnancy. 

How Does Clubfoot Look?

A child might have mild clubfoot or a more severe case. Usually, a person with clubfoot will have these features:

• One or both feet that turn inward and downward 
• A deep crease on the bottom of the foot/feet
• Feet that look deformed or misshapen
• One leg that is slightly shorter than the other
• One calf that is less developed and, as a result, thinner than the other

Types of Congenital Clubfoot

Clubfoot is divided into different classification, including:

• Idiopathic clubfoot: Also known as isolated clubfoot, this is when the condition occurs without a known cause. It’s the most easily corrected type of clubfoot.
• Neurogenic clubfoot: This type is caused by neurological conditions, including spina bifida or cerebral palsy. It can be more difficult to treat because of these underlying conditions.
• Syndromic clubfoot: This occurs when the clubfoot is a symptom of another, non-neurological condition, like dwarfism (a condition of short stature due to genetics or a medical condition) or arthrogryposis (a condition that affects the muscles). Like neurogenic clubfoot, syndromic clubfoot is more difficult to treat because of these underlying health concerns. 

Correcting Clubfoot Through Treatment

Most cases of clubfoot can be corrected, often without surgery. However, treatment is always needed. This is not a condition that a child will outgrow, and oftentimes symptoms become worse if left untreated.

Progressive Casting

Progressive casting, also known as the Ponseti method, is the first course of treatment for clubfoot. This treatment usually begins a week or two after birth. An orthopedist (a medical specialist of conditions of the musculoskeletal system) gently stretches the foot, then holds it in place with a cast. This is repeated every seven to 10 days, with a new cast applied each time.

During the fourth or fifth appointment, the orthopedic surgeon uses a local anesthetic to cut and lengthen the Achilles tendon. This procedure is known as an Achilles tenotomy, and about 90% of children with clubfoot will need it. After that procedure, the baby wears a cast for two to three weeks.

When that cast is removed the child is fitted with a foot brace. They wear this 23 hours a day for two to three months. Then, they wear it for 12 hours a day (usually when sleeping) until about the age of 4 or 5.

This method of casting and bracing resolves clubfoot for 90% of patients.

Physical Therapy

Another treatment for clubfoot includes an intensive physical therapy regimen known as the French method. This involves daily stretching and taping of the foot to gain range of motion. Parents must visit a specially trained physical therapist about three times a week, and provide daily stretching and taping at home.

The intense phase of this treatment lasts for about three months, but daily stretching needs to continue until a child is about 3 years old. The French method has the same effectiveness as progressive casting.

Surgery

Some children need surgery to correct clubfoot. This is the last choice for treatment, since it causes the foot to be stiff as the child grows. Even if your child needs surgery, healthcare providers usually recommend a nonsurgical method first, since that can lead to less invasive surgery.

There are two general types of surgical procedures. The less-invasive option involves an Achilles tenotomy and an anterior tibial tendon transfer, a procedure that moves the tendon that runs along the front of the ankle.

Children with severe cases of clubfoot will need a major foot reconstruction. After that surgery, they’ll wear a cast with pins holding the foot in place for up to six weeks. When the pins are removed they’ll need another cast for about a month, then special shoes for roughly a year after surgery.

Long-Term Clubfoot Complications 

Most children with clubfoot who get prompt treatment have a full recovery and a great prognosis. They’re able to walk normally, wear regular shoes, and even participate in sports and other activities. 

However, they may experience some ongoing complications, including:

• The clubfoot being a size smaller than the other foot
• The affected leg being slightly shorter
• Less-developed calf muscles, leading to sore legs or tiredness
• Pain and stiffness, especially after surgery

Summary

Clubfoot is a common deformity that occurs in about 1 in every 1,000 births. It’s highly treatable, and in the United States, treatment often begins a week or two after a child is born. Nonsurgical treatments work for about 90% of people with clubfoot. However, children with severe clubfoot, a recurrence or the condition, or other health concerns may need surgery to correct the condition.

While the prognosis is good, your child may experience some lingering complications. This includes one foot that is slightly smaller or a tendency for their leg muscles to become tired more quickly than children of their same age.