ConditionandTreatments

Overview

Clubfoot, also known as talipes equinovarus, is a congenital deformity where one or both feet are twisted out of shape or position. It is a common birth defect that can affect the bones, muscles, tendons, and blood vessels of the foot. Without treatment, the foot remains twisted, which can cause difficulty in walking and wearing shoes.

Signs and Symptoms

• Twisted Foot: The most obvious sign is the foot pointing downward and inward, with the sole facing sideways or even upward.
• Shortened Foot: The affected foot may appear shorter than the other foot.
• Underdeveloped Calf Muscles: The calf muscles on the affected side may be underdeveloped.
• Stiffness: The foot may be stiff and difficult to move.

What Causes Clubfoot?

The exact cause of clubfoot is unknown, but it is believed to result from a combination of genetic and environmental factors:

• Genetics: Genes play a crucial role in determining your child’s physical characteristics and growth. An issue with one or more genes, which are inherited from the parents, could lead to the development of clubfoot.
• Environment: Certain environmental factors, such as drug use and smoking during pregnancy, may increase the risk of a baby being born with clubfoot.

Types of Clubfoot

• Congenital Clubfoot: Present at birth and occurs without any known cause.
• Syndromic Clubfoot: Associated with neuromuscular disorders such as spina bifida.
• Positional Clubfoot: Caused by the baby’s position in the womb and typically resolves on its own or with minimal intervention.

Diagnosis

Clubfoot is usually diagnosed through a physical examination after birth. In some cases, it can be detected before birth through prenatal ultrasound.

Treatment

Treatment for clubfoot involves various methods. Your care team will discuss the best options for your child. Treatments include:

• Ponseti Method: Utilizes stretches and casts to correct the curvature of the foot.
• French Method: Involves stretches and splints to adjust the foot’s position.
• Bracing: Special shoes are used to maintain the foot at the correct angle.
• Surgery: Considered if other methods are unsuccessful.

Ponseti Method

The Ponseti method is the most common treatment and involves serial casting over two to three months, starting within the first two weeks after birth. An orthopedic surgeon performs this method by:

• Stretching the baby’s foot towards the correct position.
• Applying a cast from the toes to the upper thigh.
• Repeating this process every four to seven days with a new cast, gradually moving the foot closer to the correct position.

Before the final cast, the surgeon typically performs an Achilles tenotomy, which involves:

• Cutting the baby’s Achilles tendon in a quick procedure without needing stitches.
• Applying a new cast as the tendon heals over three weeks, allowing it to grow to a typical length.

Post-treatment, the child may need stretching exercises and special shoes or a foot brace for a few years.

French Method

Similar to the Ponseti method, this treatment uses splinting and taping instead of casting. A physical therapist starts the treatment soon after birth, requiring daily sessions for two months. Parents are taught how to perform the splinting and taping at home. This method may also require an Achilles tenotomy.

Bracing

Bracing is recommended after completing the Ponseti or French method to prevent the foot from reverting to the incorrect position. The brace, often called “boots and bar,” is worn daily for three months and then only during naps or nighttime for up to four years.

Surgery

Surgery is an option for severe cases or when nonsurgical methods fail. Ideally performed before the child starts walking, the procedure involves:

• Lengthening the heel cord and correcting other foot issues.
• Inserting pins to maintain the foot’s position.
• Applying a cast post-surgery.

A few weeks later, the cast and pins are removed, and a new cast is applied for another four weeks. To prevent recurrence, bracing or special shoes may be recommended.

Risks of Clubfoot Surgery

Surgical risks include nerve injury, infection, bleeding, and stiffness.

FAQs

Q: What causes clubfoot?

A: The exact cause of clubfoot is unknown, but it may be related to genetic and environmental factors.

Q: Can clubfoot be treated successfully?

A: Yes, with early treatment, most children with clubfoot can have normal-looking feet and be able to walk normally.

Q: Is clubfoot painful?

A: Clubfoot itself is not painful in babies, but if left untreated, it can cause pain and difficulty in walking as the child grows.

Q: Can clubfoot reoccur after treatment?

A: In some cases, clubfoot can reoccur. Regular follow-up visits and possibly additional treatment may be necessary.

Q: How soon after birth should treatment begin?

A: Treatment usually begins within the first week or two after birth for the best outcomes.

Q: Are there any complications associated with clubfoot treatment?

A: Complications are rare but can include infection, nerve damage, or the need for additional surgeries.

Message From Yatharth Hospitals

As a parent, discovering that your newborn or fetus has an unexpected condition can be overwhelming. You may have spent your pregnancy envisioning adorable outfits for your baby, not the casts, splints, or braces they might need. However, clubfoot is a common birth defect, and treatment is highly effective.

It's crucial to follow the treatment schedule diligently to maximize the chances of success. With appropriate treatment, many children with clubfoot can walk, run, and even participate in sports without pain. Discuss the best therapy options for your child's clubfoot with your healthcare provider to ensure the best possible outcome.