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All about Clubfoot | Parents’ Guide

This article is a part of Global Clubfoot Awareness Parv, an initiative at Krup Health to spread awareness about newborn deformity.

What is clubfoot?

Clubfoot, also known as talipes equinovarus, is a common congenital condition where a baby’s foot or feet are turned inward, with the bottom often facing sideways or upwards. It occurs due to tight tendons in the baby’s leg and foot, causing the foot to twist inward. Approximately 1 out of every 1,000 newborns is born with clubfoot, and about half of babies born with clubfoot have it in both feet.

While extensive surgery was once the primary treatment for clubfoot, modern healthcare providers now use a combination of nonsurgical methods and a minor procedure to correct the condition. Clubfoot can be mild or severe and makes it harder for the child to walk normally. Doctors generally recommend treating it soon after birth to prevent complications. Successful treatment usually doesn’t require surgery, but sometimes follow-up surgery is necessary.

What are the symptoms of clubfoot?

If your child has clubfoot, you may notice the following symptoms:

1. The foot appears twisted downward and inward, with the top of the foot facing inward and the heel turned inward as well.
2. In severe cases, the foot may appear to be rotated so much that it looks like it’s upside down.
3. The affected foot or leg may be slightly shorter than the other.
4. The calf muscles in the affected leg may be underdeveloped compared to the unaffected leg.
5. The affected foot may also have a limited range of motion, making it difficult for the child to move it freely.
6. The foot may feel stiff or rigid to the touch, especially around the ankle joint.
7. In some cases, the affected foot may have a smaller size or abnormal shape compared to the other foot.

Despite its unusual appearance, clubfoot typically doesn’t cause any pain or discomfort to the child.

What causes clubfoot?

While the exact cause of the shortened tendons is often unknown, there are several factors that may contribute to the development of clubfoot:

1. Genetics:

Clubfoot tends to run in families, suggesting a genetic component to the condition. Children with a family history of clubfoot are at a higher risk of being born with the condition.

2. Position in the womb:

Certain factors during fetal development, such as the positioning of the baby in the womb, may increase the risk of clubfoot. Babies who are positioned with their feet pointing downward (breech position) may be more likely to develop clubfoot.

3. Environmental factors:

Some environmental factors, such as smoking during pregnancy or exposure to certain toxins, may increase the risk of clubfoot.

4. Other medical conditions:

Clubfoot may be associated with other medical conditions, such as spina bifida or arthrogryposis, which affect muscle and joint development.While the exact cause of clubfoot may vary from case to case, it is generally believed to result from a combination of genetic and environmental factors. Early detection and treatment of clubfoot are crucial for ensuring the best possible outcome for affected children.

Types of clubfoot

1. Idiopathic Clubfoot:

This is the most common type of clubfoot, where the exact cause is unknown. It’s often present at birth and may occur in otherwise healthy babies.

2. Syndromic Clubfoot:

This type of clubfoot is associated with other congenital conditions or syndromes, such as arthrogryposis or spina bifida. The presence of clubfoot may indicate a more complex underlying condition.

3. Positional Clubfoot:

Also known as positional talipes, this type of clubfoot occurs due to the baby’s position in the womb. It is usually flexible and can be corrected without treatment.

4. Neurogenic Clubfoot:

Neurogenic clubfoot is caused by a problem with the nerves that control the muscles in the foot. It can result from conditions like spina bifida or cerebral palsy.

5. Teratologic Clubfoot:

This is the most severe form of clubfoot and is typically associated with serious congenital abnormalities. It may involve significant foot deformities that are difficult to correct.

6. Nonisolated Clubfoot:

Nonisolated clubfoot refers to clubfoot that occurs in conjunction with other foot abnormalities or musculoskeletal conditions, such as vertical talus or arthrogryposis. These additional conditions may complicate treatment and require a multidisciplinary approach for management.

Each type of clubfoot requires a tailored approach to treatment based on its severity and underlying cause. Early diagnosis and intervention are crucial for the best outcomes.

Risk factors of clubfoot

1. Family History:

Children born to parents who had clubfoot are at a higher risk of developing the condition themselves.

2. Gender:

Boys are twice as likely to have clubfoot compared to girls.

3. Twins:

Clubfoot is more common in twins, especially in the second twin.

4. Maternal Smoking:

Pregnant women who smoke are more likely to have babies with clubfoot.

5. Maternal Age:

Mothers who are older than 30 years have a slightly higher risk of having a baby with clubfoot.

6. Position in the Womb:

Clubfoot may occur more frequently in babies who are in breech position (feet first) in the womb.

7. Genetic Factors:

Certain genetic factors may contribute to the development of clubfoot, although the exact genes involved are not fully understood.

8. Environmental Factors:

Exposure to certain environmental factors, such as toxins or medications during pregnancy, may increase the risk of clubfoot.

9. Other Birth Defects:

Clubfoot may occur in association with other congenital anomalies or syndromes, which can increase the overall risk.

10. Congenital Conditions:

Some congenital conditions, such as spina bifida or arthrogryposis, may be associated with clubfoot.

11. Not Enough Amniotic Fluid During Pregnancy:

Low levels of amniotic fluid (oligohydramnios) during pregnancy have been linked to an increased risk of clubfoot.

How is clubfoot diagnosed?

Clubfoot is typically diagnosed shortly after birth through a physical examination by a healthcare provider. Here’s how clubfoot is diagnosed:

1. Physical Examination:

The healthcare provider will carefully examine the newborn’s feet, looking for characteristic signs of clubfoot. These signs may include:

  • The top of the foot is twisted downward and inward.
  • The foot may appear unusually small and broad.
  • The affected foot may have a high arch, and the heel may be turned inward.
  • The calf muscles on the affected side may be underdeveloped.

2. X-rays:

In some cases, X-rays may be ordered to assess the severity of the clubfoot and to rule out any associated bone abnormalities.

3. Ultrasound:

During pregnancy, an ultrasound may detect clubfoot in the womb. However, prenatal ultrasound is not always reliable for diagnosing clubfoot, and a postnatal examination is necessary for confirmation.

4. Family History:

A family history of clubfoot or other musculoskeletal conditions may also be considered when diagnosing clubfoot.

5. Other Tests:

Additional tests, such as genetic testing or imaging studies, may be recommended if clubfoot is suspected to be part of a larger syndrome or if there are other associated abnormalities.

Once clubfoot is diagnosed, medical professionals can develop a treatment plan tailored to the individual needs of the child. Early diagnosis and intervention are essential for successful treatment and optimal outcomes.

Who treats clubfoot?: Treatment Specialists

1. Pediatric Orthopedic Surgeon:

A pediatric orthopaedic surgeon specializes in the diagnosis and treatment of musculoskeletal conditions in children, including clubfoot. They are responsible for evaluating the severity of the deformity, determining the most appropriate treatment plan, and performing any necessary surgical procedures.

2. Orthopedic Physician Assistant (PA):

Orthopaedic physician assistants work closely with orthopaedic surgeons to provide comprehensive care to patients. They may assist in the evaluation, diagnosis, and treatment of clubfoot, as well as provide pre – and post-operative care.

3. Physical Therapist (PT):

Physical therapists play a crucial role in clubfoot treatment by providing exercises and stretches to improve muscle strength and flexibility. They also teach parents how to perform home exercises and help monitor the child’s progress throughout the treatment process.

How is clubfoot treated?

Treatment for clubfoot involves various methods, each tailored to address the unique needs of the child. Here’s a more detailed look at the four main treatment methods:

1. Ponseti Method:

Developed by Dr. Ignacio Ponseti, this method is the most widely used and successful non-surgical approach for treating clubfoot. It involves a series of gentle manipulations and stretches of the foot and ankle to gradually correct the deformity. After manipulation, the foot is placed in a plaster cast to hold it in the corrected position. The cast is changed weekly, gradually moving the foot into a more normal position. Once the correction is achieved, the child wears a special brace, known as a Denis Browne bar, at night to maintain the correction.

2. French Method:

Similar to the Ponseti method, the French method also involves gentle manipulation and stretching of the foot, followed by the application of splints or braces. However, the French method typically uses a different type of splint or brace compared to the Ponseti method. The goal is to gradually correct the position of the foot and maintain the correction over time.

3. Bracing:

Bracing is an essential component of clubfoot treatment, regardless of whether the Ponseti or French method is used initially. Braces are worn by the child to prevent relapse and maintain the corrected position of the foot. The most common type of brace is the Denis Browne bar, which consists of shoes attached to a metal bar. The child wears the brace at night for several years to ensure that the correction is maintained as the foot grows.

4. Surgery:

In cases where conservative methods fail to correct the deformity or if the clubfoot is particularly severe, surgery may be necessary. Surgical correction of clubfoot typically involves releasing tight tendons, lengthening or repositioning muscles, and realigning bones in the foot and ankle. Surgery is usually performed when the child is older, often between 9 and 12 months of age. However, surgery may also be considered for older children and adults with untreated or recurrent clubfoot.

These treatment methods are often used in combination to achieve the best outcomes for children with clubfoot. Your healthcare provider will determine the most appropriate treatment plan based on factors such as the severity of the deformity, the child’s age, and any associated medical conditions. Early intervention and consistent follow-up care are key to successful treatment and long-term outcomes for children with clubfoot.

Is it Possible to Prevent Clubfoot?

Quality healthcare before and during pregnancy is essential for giving your child the best possible start in life. Consider scheduling a preconception checkup even before you plan to conceive. During this visit, a healthcare provider ensures your overall health is optimal for pregnancy.

If you’re at a high risk of having a baby with clubfoot or other birth defects, it’s wise to consult a genetic counsellor. These professionals specialize in birth defects and genetic conditions, providing personalized advice and support. Additionally, ensure you undergo screenings for infections such as the Zika virus. Treating infections before pregnancy can significantly increase the likelihood of a healthy pregnancy and baby.

Can clubfoot return?

Clubfoot treatment is typically successful, but there’s a chance it can come back. Here are some factors that can contribute to the recurrence of clubfoot:

1. Incomplete Correction:

If the initial treatment doesn’t fully correct the clubfoot deformity, it may return over time.

2. Non-compliance with Bracing:

After the initial correction with casts, bracing is essential to maintain the foot’s corrected position. Failure to comply with bracing recommendations increases the risk of recurrence.

3. Growth Spurts:

During growth spurts, especially in adolescence, there’s a possibility of the foot becoming misaligned again.

4. Associated Conditions:

Sometimes, clubfoot is associated with other conditions that may affect its recurrence.

While clubfoot can return, early detection and prompt treatment can help minimize the risk. Regular follow-ups with healthcare providers are crucial to monitor the foot’s development and intervene if necessary.

Famous People born with Clubfoot

No. of celebrityFamous Person NameCelebrity Occupation
1.Parv ThackerYoungest Singer, Child Actor, Author, Changemaker
2.ClaudiusRoman emperor
3.Steven GerrardSoccer player
4.Lord ByronPoet 
5.Jonathan Broom EdwardsParalympic High Jump Gold Medalist
6.Prince TalleyrandStatesman
7.Aaron MckibbinParalympic Table Tennis Bronze Medalist
8.Thaddeus StevensPolitician
9.Troy AikmanDallas Cowboys quarterback
10.Damon WayansComedian
11.Kristi YamaguchiOlympic figure skating
12.Gary BurghoffActor
13.Jim MecirBaseball pitcher
14.Dudley MooreActor
15.Larry SherryBaseball pitcher
16.Steven GerrardFootball Player
17.David LynchFilm director
18.Mia HammUS women’s national soccer player
19.Petra KlinglerSwiss Olympian and World Champion climber
20.Freddy SanchezAmerican baseball second baseman
21.Mpumelelo MhlongoLong Jump
22.Charne FelixLong Jump
23.Bernelee DaniellMiss South Africa
Notable People born with Clubfoot