Clubfoot: Information on Causes, Diagnosis & Treatments
Clubfoot (talipes equinovarus) refers to an assortment of foot anomalies that typically develop when the child was still in the wound. The newborn's foot is usually twisted in an opposition or shape. The fairly common congenital defect causes the development of tendons connecting bone to muscle to grow much shorter than normal. Most children born with a clubfoot have no other defect at birth.
Cases range from mild to severe and only approximately fifty percent of all infants who are born with a clubfoot have the condition on both feet. However, the condition makes it significantly more challenging to walk. Fortunately, doctors have various recommended treatments to correct the condition soon after birth, including nonsurgical options. However, the child will usually require some form of follow-up surgery later in life.
The most common characteristics associated with clubfoot include:
- A foot pointing downward
- A heel or foot that developed much smaller than normal
- The rotation of the front of the foot toward the opposing foot
- A foot that turns inward
- The bottom of the foot pointing upwards
The condition is typically painless in the newborn. Even so, doctors often recommend immediate treatment. Even with successful treatment, clubfoot often causes serious problems later in life.
Who Is at Risk for Developing a Clubfoot?
Doctors consider clubfoot as an idiopathic condition, meaning that no known cause has been identified. However, some medical scientists believe a clubfoot develops because of a combination of environmental factors and genetics. The scientists list the associated risk factors to include:
- Genetic Predisposition – Having a family history were other children or either parent was born with a clubfoot can increase the potential likelihood of the newborn developing one as well.
- Congenital Condition – In many cases, the child is born with a clubfoot because of some other congenital birth defect including a skeleton abnormality like spina bifida, which is a serious condition that develops when the tissue around the fetus' spinal cord fails to close properly.
- Environmental Factors – Smoking, infections, and the use of recreational medications, while the mother is pregnant, can increase the potential risk of the newborn developing a clubfoot.
- Low Levels of Amniotic Fluid While Pregnant – Low levels of amniotic fluid while the fetus is in the wound can increase the potential risk of the child developing a clubfoot.
Generally, most complications associated with a clubfoot do not occur until the toddler begins standing or walking. With treatment, the child typically enjoys a fairly normal life but may have some associated complications that include:
- Limited mobility
- Smaller calf size – The calf muscles on the affected leg might not develop at the same rate as the other leg.
- Varying shoe sizes – The child might have varying shoe sizes up to 1-1/2 sizes larger on the unaffected foot.
Without treatment, the child may experience more serious problems associated with their club foot that could include:
- Arthritic Conditions – Without effective treatment on the clubfoot, the child normally develops arthritis in the affected foot.
- Diminished Self-Image – As the child grows older, they often develop a poor self-image due to social norms associated with the unusual appearance of their clubfoot.
- Difficulty When Walking – Because the ankle is twisted because of the clubfoot condition, the child is often challenged to walk normally on the sole of the foot. To compensate for the problem, the child may instead walk on the ball instead of the sole of the foot or place their body weight on the outside of the foot.
- Walking Adjustment Issues – When the child adjusts their stride when walking due to their clubfoot, the walking modification can prevent the calf muscles from growing naturally. This can easily produce tough calluses and large sores on the foot that will eventually lead to an unusual or awkward gait.
A clubfoot generally appears as a twisted foot in one or more directions. The common symptoms associated with clubfoot include:
- A foot that develops where the top is twisted inward and downward that will turn the heel and increase the height of the arch.
- A foot that develops with a severe turn that makes the foot appear as though it is upside down.
- A foot that develops shorter, up to 1 cm (half-inch), than the opposing foot.
- Underdeveloped calf muscles
Even though these common symptoms appear to be uncomfortable, the child usually does not experience pain until they begin standing or walking. Normally, the doctor will identify a club foot immediately after the newborn is delivered.
Some children are diagnosed with a clubfoot while still in the womb when the doctor orders an ultrasound using sound wave technology to identify the defect. However, it is more common for a diagnosis after the child was born where there is an obvious abnormality with the mobility and appearance of the legs and feet.
In many cases, the clubfoot has grown out of position and the foot remains flexible enough to be repositioned into its normal position after birth. However, if the foot muscles and tendons are stiff or rigid the calf muscles can be very tight and require alternative treatments. Typically, the doctor will not order an x-ray to confirm the diagnosis because the bones in the foot and ankle of a newborn have not fully ossified where the bone material fills in, making it very difficult to view and in x-ray.
However, the doctor may recommend a variety of tests to rule out other health issues including muscular dystrophy and spina bifida. In addition, there may be other deformities that affect the bones in the leg or foot that are causing an abnormal appearance, and not necessarily a clubfoot.
Treating the Condition
The doctor typically has numerous options for treating clubfoot conditions, that is usually performed by an orthopedic surgeon. Until recently, surgery was generally the only option for repairing the problem. However, there are numerous advancements in medical technology in understanding of the specific defect that has provided alternative remedies. The most common treatments for clubfoot include:
- Ponseti Method – This method involves stretching and casting the affected foot where the foot is stretched toward the correct position and held in place by a cast that will hold the leg and feet from the toes to the upper thigh. Approximately every week, the cast is removed and the foot is moved into the normal position and held in place with a new cast. The entire treatment can take upwards to three months followed by aftercare when the child will need to do stretching exercises to ensure that the foot remains in the correct position and/or wear special braces or shoes.
- French Method – This method requires stretching, taping and splinting the affected foot by using tape to hold the splint in the correct position. This can take upwards to six months before the foot has adapted to the correct position.
- Surgical Options – Severe clubfoot cases often require a surgical procedure, usually before the child starts walking. After the surgery, the infant must usually wear a cast for upwards to eight weeks.
Successful treatments of mild to severe club foot conditions usually result in the child living a normal, active life.