What Causes Clubfoot?The cause of clubfoot is not well understood. While it can be associated with other congenital malformations (such as spina bifida and arthrogryposis), it may also occur independently. The cause of clubfoot is not due something the mother did during pregnancy.
The Clubfoot DeformityWhen a child is born with clubfoot, the tendons on the inside and the back of the foot are too short. The foot is pulled such that the toes point down and in, and it is held in this position by the shortened tendons.
Treatment of ClubfootThe treatment for clubfoot begins immediately after the child is born. The pediatric orthopedic surgeon will manipulate the foot and cast it on a weekly basis to try to correct the clubfoot deformity. This manipulation technique is called "The Ponseti Method," named after the doctor who has popularized this treatment.
What is the Ponseti treatment for clubfoot?
The Ponseti treatment of clubfoot consists of casting to correct the deformity. The position and timing of the casts is deliberate, and intended to stretch and rotate the foot into a proper position. Each week, the casts are replaced in a process called serial casting. The casts slowly correct the position of the clubfoot.
In about one half of cases, this manipulation is sufficient to correct the clubfoot deformity. In some cases, a surgical procedure may be necessary. During surgery, the doctor will release, or loosen, the tight Achilles tendon to allow the foot to assume its normal position. Once the casts are removed, the child will usually wear nighttime braces until about age two.
Does the Ponseti method of clubfoot treatment always work?
Unfortunately, no. In some cases, surgery is needed to correct the position of the clubfoot. Most often this is needed in cases where the child has other developmental problems (such as arthrogryposis) or if the child begins treatment more than a few months after birth.
If the clubfoot deformity is not corrected, the child will develop an abnormal gait and may have serious skin problems. Because the child will be walking on the outside of the foot, a part of the foot not designed to walk upon, the skin can break down and the child may develop serious infections. Furthermore, the abnormal gait may lead to joint wear and chronic arthritic symptoms.
Noonan KJ and Richards BS "Nonsurgical Management of Idiopathic Clubfoot" J. Am. Acad. Ortho. Surg., November/December 2003; 11: 392 - 402.