Clubfoot

Causes

Clubfoot occurs because the tendon that attaches the back of the foot to the leg, called the Achilles tendon, is too short. The reason this occurs is not known. Researchers currently suspect both genes and the environment play a role.

In some cases, clubfoot is caused by the baby’s position before birth. In rare cases, clubfoot presents as a symptom of another problem, such as spina bifida.

Risk Factors

Clubfoot is more common in boys than girls.

Other risk factors include:

• A sibling or parent with clubfoot
• Having a neuromuscular condition such as cerebral palsy or spina bifida
• Other birth defects or genetic disorders
• Breech birth – when a baby is born hips first instead of head first
• Not enough fluid surrounding the baby in the mother’s womb
• A mother who was in a smoky environment during pregnancy

Diagnosis

The diagnosis is apparent by visual examination at birth. For some babies, the diagnosis is seen on ultrasound tests while the child is in the womb.

No other testing is usually needed unless the doctor suspects an underlying genetic or neurological condition is the cause.

Treatment

Nearly all children will recover with treatment. The most common method of treatment is called the Ponseti method. With this treatment, a doctor will stretch the child’s foot back into the correct position. They then place a cast to keep it in place. This is repeated for several weeks until the baby’s foot remains aligned. A surgeon will then do a minor procedure to lengthen the Achilles tendon.

Afterward, the parent must place the baby’s feet into special shoes and braces. They must also help the baby with stretching exercises. This can continue for up to three years of life.

Surgery is necessary in severe cases or if the Ponseti method does not work.

Complications

There are usually only minor complications in children who are treated. These include:

• Shoe size – the affected foot is often smaller
• Leg length – the leg on the affected side may be a little shorter than the other leg
• Muscle size – the affected side calf muscle may be smaller than the other leg
• Flexibility – the affected foot may be less flexible

The complications in children who are not treated are more severe. These include

• Difficulty walking – the child may walk on the ball or side of the foot instead of the sole
• Arthritis – the person may develop arthritis (painful joints) as they age
• Poor self-image – particularly during the teen years

Prevention

If a person or their partner has had clubfoot, they may consider whether they wish to have genetic testing or counselling prior to conceiving.