Clubfoot

Introduction

Clubfoot is a common congenital abnormality in which the foot is turned inward. The condition derives its name from the resemblance of the curved foot to the head of a golf club. Clubfoot is an anomaly that can affect one or both feet. It is usually an isolated condition, although it is occasionally associated with other skeletal abnormalities, such as spina bifida. While a clubfoot does not, in itself, cause pain or other symptoms during infancy, the condition must be addressed soon after birth since, left untreated, it can result in serious medical problems once the child begins to walk.

Risk Factors for Clubfoot

Although the primary cause of clubfoot is unknown, the following factors increase the risk for being born with the condition, particularly if found in combination:

• Being male
• Having a family history of the condition
• Being surrounded by too little amniotic fluid during gestation
• Maternal smoking or drug use during pregnancy
• Maternal infection during pregnancy

While it was previously believed that clubfoot resulted from the fetus’s position in utero, this theory has been disproven.

Complications of Clubfoot

There are many important reasons that a clubfoot should be treated early in life. For one thing, because of its odd shape, the affected foot may be considerably smaller than its partner, requiring special footwear. More significantly, as the child learns to walk, mobility will be adversely impacted because the child may not be able to step on the sole of the foot. Complications of clubfoot may include:

• Abnormal growth of calf muscles
• Irregular gait
• Lesions or calluses on the feet
• Arthritis

Beyond all the physical disabilities and discomforts that an untreated clubfoot will cause, there are serious emotional consequences to consider such as lack of self-confidence, poor body image, and a sense of isolation.

Treatment of Clubfoot

Because of the amazing flexibility of newborn bones and joints, clubfoot treatment usually begins within 2 weeks of birth. In an attempt to avoid surgery, the baby’s foot may be maneuvered into a correct anatomical position and casted so it will remain properly aligned as it grows. Alternatively, the Ponseti or French methods may be used. These involve stretching, taping and bracing the affected feet daily and/or nightly so that they are constantly being repositioned correctly. These nonsurgical interventions, however, are not always successful.

When an operation is required to treat a clubfoot, the surgery is usually performed when the baby is between 9 and 12 months of age to ensure that not only the child’s foot and ankle, but the affected tendons and ligaments, are positioned correctly. The surgery may be an osteotomy in which a section of bone is removed or a fusion (arthrodesis) in which two or more bones are joined using a graft. After surgery, the child will be casted during recovery and may have to wear a brace nightly for several years.