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What Is Clubfoot?

Clubfoot is a common type of birth defect that affects muscles and bones in the feet. Instead of being straight, a clubfoot points down and turns in. This twisting causes the toes to point toward the opposite leg. A baby can be born with the defect in one or both feet. A clubfoot isn't painful and won't cause health problems until a child begins to stand and walk. But clubfoot that isn't treated can lead to serious problems — and even make a child unable to walk. So it's very important to begin to correct it quickly, ideally a week or two after birth.

What Causes Clubfoot?

Doctors often don't know what causes a baby's clubfoot. It's more common in boys, and can run in families. A baby with clubfoot usually has no other medical problems.

Clubfoot usually is found on an ultrasound around the 20th week of pregnancy. If not, it's diagnosed when a baby is born.

How Is Clubfoot Treated?

Clubfoot won't get better on its own. It used to be fixed with surgery. But now, doctors use a series of casts, gentle movements and stretches of the foot, and a brace to slowly move the foot into the right position— this is called the Ponseti method.

A baby with clubfoot will be treated by an orthopedic surgeon (a doctor who focuses on conditions of the bones, muscles, and joints) who has been trained in the Ponseti method. If your baby has a clubfoot, make sure that your orthopedic surgeon has had this training.

The Ponseti method is done in two phases: the casting phase and the bracing phase.

  • Casting-: The first cast is put on a week or two after the baby is born. Then, the baby returns to the surgeon about once a week for gentle moving and stretching of the foot, and placement of a new cast. The new cast turns the foot a bit more in the correct direction than the one it is replacing. Most babies will wear a series of 5 to 7 casts over a few weeks or months.
  • Bracing-: When the foot is in the correct position, the orthopedic surgeon will fit the baby with a brace (also called an "orthotic") instead of a cast. The brace is a bar with special shoes or boots at each end. It keeps the foot from twisting back to where it was before the casting. Feet grow a lot and very quickly in the first years of life. Without the brace to keep a corrected clubfoot in the proper place, that rapid growth would send the foot back into the clubfoot position.

A child will wear the brace all the time for about 3 months, and then only at night or during naps for a few years. Most kids adapt well to wearing the brace, though it can take them a day or two to get used to it.

Symptoms

If your child has clubfoot, here's what it might look like:

  • The top of the foot is usually twisted downward and inward, increasing the arch and turning the heel inward.
  • The foot may be turned so severely that it actually looks as if it's upside down.
  • The affected leg or foot may be slightly shorter.
  • The calf muscles in the affected leg are usually underdeveloped.

Despite its look, clubfoot itself doesn't cause any discomfort or pain.

When to see a doctor

More than likely your doctor will notice clubfoot soon after your child is born, based on appearance. Your doctor can advise you on the most appropriate treatment or refer you to a doctor who specializes in bone and muscle problems (pediatric orthopedist).

Causes

The cause of clubfoot is unknown (idiopathic), but it may be a combination of genetics and environment.

Risk factors

Boys are about twice as likely to develop clubfoot than girls are.

Risk factors include:

  • Family history-: If either of the parents or their other children have had clubfoot, the baby is more likely to have it as well.
  • Congenital conditions-: In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth (congenital), such as spina bifida, a birth defect that occurs when the spine and spinal cord don't develop or close properly.
  • Environment-: Smoking during pregnancy can significantly increase the baby's risk of clubfoot.
  • Not enough amniotic fluid during pregnancy-: Too little of the fluid that surrounds the baby in the womb may increase the risk of clubfoot.

Complications

Clubfoot typically doesn't cause any problems until your child starts to stand and walk. If the clubfoot is treated, your child will most likely walk fairly normally. He or she may have some difficulty with:

  • Movement-: The affected foot may be slightly less flexible.
  • Leg length-: The affected leg may be slightly shorter, but generally does not cause significant problems with mobility.
  • Shoe size-: The affected foot may be up to 1 1/2 shoe sizes smaller than the unaffected foot.
  • Calf size-: The muscles of the calf on the affected side may always be smaller than those on the other side.

However, if not treated, clubfoot causes more-serious problems. These can include:

  • Arthritis-: The affected foot may be slightly less flexible.
  • Poor self-image-: The affected leg may be slightly shorter, but generally does not cause significant problems with mobility.
  • Inability to walk normally-: The twist of the ankle may not allow your child to walk on the sole of the foot. To compensate, he or she may walk on the ball of the foot, the outside of the foot or even the top of the foot in severe cases.
  • Problems stemming from walking adjustments-: Walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the foot, and result in an awkward gait.