What Is Clubfoot?

Clubfoot is one of the most common pediatric orthopedic conditions. It is present at birth and can even be diagnosed by ultrasound before birth. If left untreated, the foot deformity can make walking extremely difficult and can be painful. Typically the heel tilts in and down and the forefoot turns in. The affected foot and calf are usually smaller than those of the unaffected leg.

What caused my child’s clubfoot?

The cause of clubfoot is unknown. While it can coexist with other conditions, most babies with clubfoot are otherwise healthy. Clubfoot affects about one baby in every 1,000 live births. Fifty percent of babies with clubfoot are affected in both feet, and males are affected slightly more often than females.

What is the incidence of club foot?

The incidence is approximately 1 in 1000 births Congenital form is responsible for about three quarters of all cases. There are no other congenital  abnormalities. The male-to-female ratio is 2:1. Bilateral involvement is found in 30-50% of cases.

Will my next child have club foot?

There is a 10% chance of a subsequent child being affected if the parents already have a child with a clubfoot and 20-30% chance for children of involved parents

Will treatment make my child’s clubfoot normal?

A. Our goal is to help the child’s foot rest flat on the ground and be flexible and pain-free. Because the tissues below the knee are affected, the clubfoot will always be a little shorter in length than the other foot, and the calf will always be slightly thinner than the other calf. Bracing and splinting are important in preventing your child’s foot from reverting back to the curved position.

What will be the treatment for the club foot?

The most commonly practiced treatment for club foot is – Ponseti Method. It involves gentle manipulation of the feet to correct the forefoot varus deformity (Toes pointing inwards) in a scientific way. This stretches out the tight medial side soft tissue structures and a cast is applied from toes to upper thigh. Every week the foot is manipulated till it gets abducted 70deg (toes point out). Thereafter a small procedure of releasing the tight heel cord done to correct the equines deformity. A plaster is put for 3 weeks. This corrects the foot deformity completely. A brace protocol needs to be followed to maintain this correction.

How long will my child have to wear a brace?

A. Bracing and splinting is a vital part of the Ponseti casting method of treatment. In the Ponseti casting method, the brace is comprised of two shoes held together by a bar. After the final cast is removed, the brace is used full-time, except for skin checks and bathing, for three months and then for 12 hours at night and during naps until at least 2 -3 years of age.

Will casting or bracing delay my child’s development?

Babies with clubfoot should develop normally. Casting, bracing and splinting should not interfere with your child’s development and must be continued to prevent recurrence of the clubfoot.

Will my child be able to play like other children?

Clubfoot, once treated, should not limit your child from participating in many athletic activities.

What if non operative treatment doesn’t correct my child’s clubfoot?

At least 94 percent of clubfeet treated with the Ponseti casting achieve good initial correction. Recurrence may require repeat casting, repeat heelcord releases or alternative bracing. If the clubfoot still cannot be maintained in a corrected position, surgery may be required. If despite conservative management the hindfoot remains in an equinus position, then an operation is required to release the soft tissue responsible for shortening, e.g. release of tibialis posterior, abductor hallucis and achilles tendons.

Commonest residual abnormality is dynamic pes varus and this is corrected with centralisation of the tibialis anterior tendon.

Further corrective surgery may be required later in childhood. This may include wedge excision of the calcaneum / cuboid bone, fusion of the mid-tarsal and sub-talar joints, or calcaneal osteotomy and talectomy. In very severe / neglected/ recurred cases use of external fixation by JESS – differential distraction technique is a very good option.

To summarize  – the earlier you start treatment the better & stick to the brace protocol!!!