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Clubfoot - Causes, Symptoms and Treatment

Published on May 19, 2022   -  4 min read

Abstract

Clubfoot is a birth defect where the foot is turned sideways. The following article will give brief information about clubfoot.

Contents

Introduction:

Physical abnormality present at the time of birth is called congenital deformity. Clubfoot is a congenital deformity where the muscles and bones of the foot are affected. It is characterized by a change in the shape and position of the normal foot. The diagnosis is made at the time of birth. Recently, most cases of clubfoot have been detected in prenatal scanning during early pregnancy.

What Is Clubfoot?

Clubfoot is a deformity where the foot is turned inwards. In medical terms, it is called talipes. The toes of the foot point towards the opposite leg. It is a prevalent condition affecting one in 1000 children. Clubfoot may affect one or both the feet. About half of the detected cases have it in both feet. The twist may be mild or severe, and the legs are usually shorter. Clubfoot is common in first-born children with a male predilection.

How Is Clubfoot Classified?

Clubfoot can be classified into two major categories. They are;

Isolated or idiopathic clubfoot is the common type occurring in children at birth and is not associated with other medical conditions.

Non-isolated clubfoot is rare and occurs with other health problems and neurological disorders.

What Are the Causes of Clubfoot?

The exact cause of clubfoot is not known. It may be a combination of genetic and environmental factors. Some hypotheses suggest clubfoot is formed due to malfunction in gestation. There is a higher risk of clubfoot running in families. If the first child has a clubfoot, the risk of developing this condition is higher in subsequent pregnancies as well. In the case of identical twins, if one baby has the condition, there is a 33 % chance the other one will have the same. Suppose the mother uses tobacco products or drugs during pregnancy, there is a greater chance for the baby acquiring clubfoot. Another reason for clubfoot manifestation is the less fluid in the amniotic sac (a pouch that contains and protects the baby).

What Are the Symptoms of Clubfoot?

Clubfoot is a visible deformity. The symptoms associated with clubfoot are;

Usually, the condition does not cause any pain by itself. But while the baby is walking, the pressure is applied on the edges of the foot instead of the sole, which can cause callus, infection, or ulcers. Thus, there is pain, inability to wear shoes, and difficulty in walking. In addition, the affected foot has a limited range of movement.

How Is Clubfoot Treated?

Clubfoot cannot get better on its own. They are primarily treated in two ways; non-surgical method and surgical method. The treatment of clubfoot aims to retain the normal function of the feet and restore painless walking with a flat sole. Ideally, treatment should be initiated shortly after birth.

Using a series of casts, gentle manipulation, stretching movements, and braces will slowly move the foot into the correct position. Non-surgical treatment is usually the combination of the Ponseti method and the French method.

Ponseti method involves casting, Achilles tendon release, and bracing.

Casting - The affected foot is slowly stretched and manipulated in a proper position, and a long cast is applied from the toe to the thigh. The cast is removed after a week, and the outcome is evaluated. Then, the process of stretching, manipulating, repositioning, and casting is done over the course of six to eight weeks until the results are satisfactory.

Achilles Tendon Release - It is also known as Achilles tenotomy. After the series of casting for eight weeks, a small Achilles tendon (heel cord) release procedure is performed. The baby may be kept under sedation, or local anesthesia can also be preferred. A small incision is placed in the area around the heel, and a very thin scalpel is used to cut and remove the tendon. The incision is closed, and the skin is covered with a small dressing. Finally, the long leg cast is applied to the corrected position and left to heal for three weeks. By this time, the clubfoot condition is fully corrected.

Bracing - After successful casting and Achilles tenotomy, the foot must be braced to prevent it from returning to the crooked position. Basically, it is a retaining method. A brace is nothing but the normal shoes or boots connected together with a bar that is bent at ten to 15 degrees. For the first three months, it is recommended to wear the brace for 23 hours a day. Later, the time can be gradually decreased (12 to 14 hours a day). The bracing regimen should be followed for at least three to four years.

The French method is another conservative, non-surgical way of treating clubfoot. It involves stretching, mobilization, and taping the foot in a corrected position. This method requires the direction of a physical therapist. Stretching and manipulation are performed every day. The taping is then stabilized using a plastic splint. This regimen is followed for the first three months, then it is thrice a week for the next four months, and the therapy is gradually weaned over a period of two to three years. Achilles tenotomy is commonly required in the french method also.

Generally, surgery is preferred when conservative management does not work. However, some cases of clubfoot are so severe that they do not respond to stretches and manipulations. In such conditions, surgery is required to correct the deformity. Usually, the surgery is performed at nine to 12 months of age. The surgery may involve removing or releasing the tendons at the back of the ankle. In most extensive cases, the release of multiple soft tissue structures of the foot is done, and the joints are stabilized with pins which can be removed after four to six weeks. Then, a long leg cast is applied and left to heal for another month, and braces are used for retaining purposes.

Conclusion:

Research shows that all the children with a clubfoot have been treated successfully. A regular active lifestyle is achieved when the treatment is started early. Though the proper management of clubfoot takes several years, it is important that the parents or caregivers are adequately educated about the condition and the importance of the treatment regimen as an uncorrected clubfoot causes lifelong physical and emotional problems.

Frequently Asked Questions


1.

Is Clubfoot Treatable?

Clubfoot is a foot deformity and usually occurs by birth. The doctor may suggest treating it shortly after birth to retain its normal functioning. The following are the various treatment methods available -

- Ponseti-method: It is a non-surgical method that involves stretching the clubfoot and then applying a cast from toe to thigh. It is then evaluated after a week and is repeated until it is corrected.

- Achilles tenotomy: A minor surgical procedure is performed after the casting procedure. It involves cutting and lengthening the Achilles tendon at the heel region.

- Bracing: Boots or shoe-like braces are worn by the affected child for the whole day during the initial phase, and later the time of wearing it is gradually decreased. It is done to retain the foot position.

- Surgery: The surgeon may reposition the tendon and ligament during the procedure. It is then maintained with casting and bracing after surgery.

2.

Does Clubfoot Heal on Its Own?

Clubfoot is a congenital disability that affects the muscles and bones of the feet. One or both the feet may be affected. It does not go away on its own and necessitates medical attention. The doctor may suggest treating it within weeks after birth. In addition, immediate treatment is essential, without which it may affect normal walking. Several non-surgical options like casting and bracing may aid in retaining the normal function of the foot. The sooner it is repaired, the better the outcome.

3.

Is Clubfoot a Genetic Anomaly?

Clubfoot is a common congenital disability that affects the muscles, tendons, and bones of the foot. Usually, both the feet are involved, which may affect their normal function. The actual cause of clubfoot is not known. However, several genetic and environmental factors trigger its occurrence. Studies show that in 20 % of newborns, genetic changes (mutation) result in a clubfoot foot. Several genetic disorders like trisomy 18, congenital myotonic dystrophy, etc., are associated with the occurrence of clubfoot.

4.

How Does a Clubfoot Appear?

Clubfoot is a common congenital disability; the characteristics of clubfoot are listed down:

- The foot’s top is twisted downwards and inwards.

- As a result, the foot may look upside down.

- The affected leg appears short.

- The muscles of the affected foot are also shorter.

5.

When Is Clubfoot Best Treated?

Clubfoot (talipes) is a foot deformity present by birth. It affects the muscles and bones of the feet, causing them to point inwards and downwards. The clubfoot can be diagnosed by routine ultrasound during the early pregnancy; however, it cannot be treated at that time. It is a visible deformity that is noted at the time of birth. The clubfoot is treated one or two weeks after birth to achieve the best results. The physiotherapy, including casting and bracing, is repeated in weeks until the proper foot position is achieved.

6.

Does It Pain During Clubfoot Treatment?

The clubfoot deformity is treated within weeks after birth. It either involves casting by the Ponseti method or through the surgical procedure. The child’s muscles, tendons, and bones in the foot are affected; therefore, the doctor may try manipulating, stretching, and attaching a cast. The muscles and tendons are usually flexible in infants, and manipulating them does not cause any pain. In the case of surgery, the doctor may numb the site using a local anesthetic agent so pain is not felt.

7.

What Causes Clubfoot?

Clubfoot is also known as talipes; the main factor causing it is still unknown. Genetic and environmental components are associated with its occurrence. Studies also show that clubfoot may run in families. The factors that increase the risk of clubfoot are listed down:

- Smoking during pregnancy.

- Decreased level of amniotic fluid during pregnancy.

- Genetic disorders like trisomy 18, congenital myotonic dystrophy, etc., may cause clubfoot.

- Family history.

8.

Can Clubfoot be left Untreated?

A congenital deformity known as the clubfoot causes twisting the foot inwards and downwards. Several genetic and environmental factors are associated with the occurrence of clubfoot. It is usually treated within weeks after birth by casting, racing, or surgical method. If not treated at the earliest, it may cause the following complications:

- Pain.

- Difficulty in walking.

- Irregular leg length.

- Calluses in feet.

- The unusual appearance of feet may look unpleasant.

9.

Which Treatment Is Best for Clubfoot?

The clubfoot is corrected after birth by various non-surgical and surgical methods. However, the Ponseti process of repairing the clubfoot is considered an effective treatment. The doctor manipulates the affected foot by stretching it to the correct position during the procedure. Then, a cast is applied to the foot to retain the corrected position. The doctor may repeat the process every five to eight weeks until the desired position is acquired. When the non-surgical method does not show improvement, the doctor opts for surgical correction.

10.

Is Clubfoot a Disability?

Clubfoot is considered a locomotive disability, meaning the restriction of limb movement due to affected muscles and joints. But, if treated at the earliest possible, the individual may live an everyday life. The walking and other limb movements are improved with the clubfoot correction. Even though it may be diagnosed with ultrasound during pregnancy, the treatment starts weeks after birth. The good news is that the treatment of clubfoot is cost-effective, and the prognosis is also good.

11.

When Does Clubfoot Heal Completely?

The clubfoot is corrected mainly by the Ponseti method. In which the Achilles tendon is stretched and manipulated to the proper position. Later a casting is applied to it and is retained for a few weeks. The doctor may check the foot position and repeat the procedure if needed. The tendon usually takes three weeks to heal completely. The clubfoot is wholly treated if the tendon regrows to its correct position. Then the doctor may suggest braces to support the foot if required.

Last reviewed at:
19 May 2022  -  4 min read

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