Clubfoot in babies is a condition that occurs due to smaller tendons (tissues that connect the muscles to the bones). This results in babies having feet that are twisted or out of shape; hence the condition includes many congenital foot abnormalities.
Clubfoot is a common congenital malformation in babies. Almost half of the babies having clubfoot may have it on both the feet (bilateral). In addition, sometimes other congenital anomalies may occur along with clubfoot. Casting and bracing are the two techniques used to treat clubfoot. Sometimes, surgery may also help correct the anomaly successfully.
Read on to know more about clubfoot, its symptoms, causes, risk factors, treatment, and prevention.
Symptoms And Signs Of Clubfoot In Babies
You may notice the following signs of clubfoot in a baby (1).
- The top of the foot can be twisted inward or downward.
- The heel may turn inward and increase the arch of the foot.
- The foot may appear upside down in severe cases.
- The affected foot and leg can be shorter.
- The calf muscle in the affected leg can be underdeveloped.
Clubfoot does not seem to cause symptoms such as pain or discomfort in babies. However, the foot’s abnormal shape or position may interfere with walking, so early management is recommended. Usually, it is the attending pediatrician who notices the deformity first and will refer these newborns with foot abnormalities to pediatric orthopedic surgeons for immediate evaluation and management.
Causes And Risk Factors For Clubfoot
The exact cause is unknown. Clubfoot could occur due to genetic and environmental factors. Usually, boys have twice the risk of developing clubfoot than girls.
The following risk factors may increase the chance of clubfoot in babies (2).
- Positive family history may increase the risk of developing clubfoot, especially if the parents or siblings have it.
- Maternal smoking during pregnancy may increase the risk of congenital anomalies, such as clubfoot.
- Oligoamnios (low amniotic fluid volume) may increase the risk of clubfoot.
- Other congenital conditions, such as congenital skeletal anomalies and spina bifida, are some common congenital anomalies associated with clubfoot.
Preconception care and early prenatal care may help decrease the risk of congenital anomalies in babies. You may discuss with your obstetrician if you have a family history of congenital abnormalities.
Complications Of Clubfoot In Babies
Clubfoot alone does not cause any complication until your baby reaches the age where he/ she starts standing or walking. The anomaly in the foot and the associated anomalies may cause the following complications (3).
- Movement difficulties may occur due to less flexibility of the affected foot.
- The short length of the affected leg could cause mobility issues.
- The size of feet could differ.
- Calf size differences may develop due to unusual gait caused by clubfoot.
Untreated clubfoot may lead to the following severe problems in children over time.
- Poor gait or inability to walk normally due to twisted ankles. Children may walk on heels, sides, or top of the foot in severe cases.
- Calluses or large sores on foot are common due to abnormal gait
Older children may require physical therapy to learn to walk normally after surgical correction of the clubfoot. Babies who undergo clubfoot repair before they start walking or standing learn to walk naturally and may not develop any issues associated with clubfoot.
Prevention Of Clubfoot In Babies
It is not possible to prevent clubfoot entirely since its precise cause is unknown. However, the following precautions may help reduce the risk of clubfoot in some babies (1).
- Avoid cigarette smoke and secondhand smoke during pregnancy.
- Avoid alcohol, illicit drugs, and non-prescription medications during pregnancy.
- Seek adequate preconception care and early prenatal care.
- Take supplements, such as folic acid, as recommended since these may prevent conditions, such as spina bifida and other neural tube defects, that are associated with it.
- Take necessary vaccinations to avoid any adverse effects of infections on the fetus.
Diagnosis Of Clubfoot
An observation of the shape and position of the newborn’s foot is usually enough to diagnose clubfoot. X-ray is often ordered to check the severity of the clubfoot (1) and prompt referral to a pediatric orthopedic surgeon for further evaluation and management.
Clubfoot could be noted during prenatal visits, usually during the routine ultrasound at 20 weeks of gestation. However, nothing can be done to treat the condition during the prenatal stage. The doctor may refer you to genetic counselors, and genetic testing is often recommended to determine the cause.
Treatment For Clubfoot In Babies
Treatment usually begins in the first couple of weeks after birth since the newborn’s tendons and joints are flexible. Clubfoot treatments aim to provide better foot appearance and mobility before a baby learns to walk and prevent long-term problems. The following are the clubfoot treatments for babies (4).
1. Stretching and casting (Ponseti method)
This treatment method involves moving the baby’s foot into the correct position and placing it within a cast. The cast helps hold the correct position of the foot. The reposition and casting are done every week for several months to achieve a normal foot position. Percutaneous Achilles Tenotomy (surgical lengthening of the Achilles tendon) is performed at the end of the Ponseti method.
Stretching exercises and special shoes and braces are recommended after the realignment of the foot. Usually, babies have to wear shoes and braces for three months. They will then have to wear the braces at night and during naps for three years further. The success of this method depends on following all the doctor’s instructions. Not using the braces as instructed may make the procedure ineffective at treating clubfoot.
Surgical correction of clubfoot is required in severe cases that may not respond to non-surgical management. Surgery involves lengthening and repositioning the tendons to realign the foot into a normal position.
A cast is placed for a couple of months after the surgery. The baby may have to wear braces for a year to prevent the recurrence of clubfoot.
Clubfoot in babies is a common congenital anomaly, and most cases can be diagnosed at birth. Early intervention may help cure mild cases of clubfoot without any surgery. Severe cases may require surgery and subsequent management. You may discuss a treatment plan that works the best for your baby with the pediatrician. Timely treatment before the onset of walking could help avoid any long-term complications.
2. Clubfoot; John Hopkins Medicine
3. Clubfoot; St. Clair Hospital
4. Clubfoot; The American Academy of Orthopaedic Surgeons