What is Club foot?
In clubfoot, the tendons on the inside of the leg are shortened, the bones have an unusual shape, and the Achilles tendon is tightened. If left untreated, the person may appear to walk on their ankles or the sides of their feet.
In an infant born with clubfoot:
- the top of the foot twists downwards and inwards
- the arch is more pronounced and the heel turns inward
- in severe cases, the foot may look as if it is upside-down
- the calf muscles tend to be underdeveloped
- if only one foot is affected, it is usually slightly shorter than the other, especially at the heel
Most children will have only a clubfoot and no other condition, but sometimes clubfoot occurs with other problems, such as spina bifida.
What are the risk factors for clubfoot?
Risk factors for clubfoot include the following:
- Gender: Males are twice as likely as females to be born with clubfoot.
- Genetics: If a parent who was born with clubfoot, their children have a higher chance of having a child with the same condition. The risk is higher if both parents have the condition.
What causes club foot?
Clubfoot is mainly idiopathic, which means that the cause is unknown. Genetic factors are believed to play a major role, and some specific gene changes have been associated with it, but this is not yet well understood. It appears to be passed down through families.
It is not caused by the fetus’ position in the uterus.
Sometimes it may be linked to skeletal abnormalities, such as spina bifida, or a developmental hip condition known as hip dysplasia, or developmental dysplasia of the hip (DHH).
It may be due to a disruption in a neuromuscular pathway, possibly in the brain, the spinal cord, a nerve, or a muscle.
Could this have been detected & treated during pregnancy?
It can be detected before birth by ultrasound, especially if both feet are affected. If it is detected before birth, no treatment is possible until after the baby is born.
Whether the condition is detected during pregnancy or after birth, doctors will recommend more tests to check for other health problems, such as spina bifida.
X-rays may help to observe the deformity in more details.
What will be the further treatment?
A clubfoot will not improve without treatment. Leaving the foot untreated increases the risk of complications later in life.
Treatment should be started during the early couple of weeks after birth. The aim is to correct the foot soon so that the final goal to render the feet functional and free of pain is achieved.
The Ponseti method
The primary way of treatment is the Ponseti method, in which a specialist manipulates the baby’s foot with their hands. The aim is to correct the bend in the foot. Then a plaster cast is applied from the toes to the thigh, to hold the foot in position.
There is normally one session a week. The manipulation and casting are done very gently, and the patient should experience no pain.
At each session, the plaster cast is changed, and each time the foot is corrected a little more. The whole process may be done 4 to 7 times. A cast must be worn following manipulation to help reshape the foot. Minor surgery may follow the Ponseti method treatment, if necessary, to release the Achilles tendon.
After the foot is corrected, the patient needs to wear special boots attached to a brace to hold the foot, or feet, in the best position. This is to prevent relapse.
For about 3 months, the boots are worn 23 hours a day. After this, they are only worn at night and during daytime naps, until the age of around 3-4 years.
For the Ponseti method to be effective, it has to be done very early on, and parents have to make sure the boots are worn according to instructions.
If instructions are not followed strictly, the foot may return to its original position, and treatment has to start again.
While the infant is wearing a cast, parents should monitor for changes in skin color or temperature, as this could mean that the cast is too tight.
Any role of Surgery?
Surgery may be used if other methods do not work, but this is normally on a case-by-case basis.
Surgery aims to adjust the tendons, ligaments, and joints in the foot and ankle, for example, by releasing the Achilles tendon or by moving the tendon that goes from the front of the ankle to the inside of the foot.
More invasive surgery releases soft tissue structures in the foot. The surgeon then stabilizes the foot using pins and a cast.
Surgery may lead to overcorrection, stiffness, and pain. It has also been associated with arthritis later in life.
Any Complications?
A well-treated clubfoot should not leave a child at a disadvantage. They will be able to run and play like other children.
Left untreated, however, complications can occur.
There will usually be no pain or discomfort until the child comes to stand and walk. It will be hard to walk on the soles of the feet.
Clubfoot can cause long-term mobility issues.
Instead, the child will have to use instead the balls of the feet, the outside of the feet, and in very severe cases the top of the feet.
There is a long-term risk of eventually developing arthritis.
The inability to walk properly can make it difficult for a person with clubfoot to participate fully in some activities. The unusual appearance of the foot may also cause self-image problems.
Why one should not worry about clubfoot?
Just have a look at the list of few famous people born with a clubfoot who have succeeded in various professions including sports.
- Dudley Moore, the English actor
- Damon Wayans, the American actor and comedian
- Troy Aikman, the American football player, TV presenter
- Steven Gerard, the English soccer player
- Kristi Yamaguchi, winner of 1992 Olympic gold medal for figure skating
Parents of children with a clubfoot may feel anxious, but with proper treatment the individual should, in time, be able to use their foot without major difficulty.
