When they’re first born, or just starting to walk, children’s legs and feet often don’t quite look like their adult versions yet. At this stage, bones are still soft and growing, and minor rotations in the leg (in-toeing or out-toeing) or arches that disappear when the child stands (called flexible flatfoot) are common and usually nothing to worry about.
However, in about 1 out of every thousand births, one or both feet are severely twisted—so much that the sole of the foot faces sideways or upward. This is called clubfoot, and treatment must begin soon after birth to correct the problem before your child begins walking.
Causes of Clubfoot
Mechanically and structurally speaking, clubfoot is caused by an imbalance in the tendons that connect the muscles of the leg to the bones of the feet: they’re too short and tight, pulling and twisting the foot inward.
In most cases, the underlying cause of this tendon imbalance is unknown. Sometimes there’s an accompanying health problem or neuromuscular condition, such as spina bofida, at play; such cases tend to be more resistant to treatment.
However, most of the time there’s no obvious underlying cause for clubfoot. A combination of both genetic inheritance and environmental factors (such as the condition in the womb) are suspected as likely contributors, and there does seem to be greater risk for those with a family history of the condition.
Symptoms of Clubfoot
Clubfoot deformities can range from relatively mild to extremely severe, with the bottoms of feet turned entirely upward and creased along the bottom. A foot affected by the condition will tend to have weaker calf muscles and could be up to half an inch shorter than an unaffected leg.
Despite the appearance, you’ll be relieved to know that clubfoot is virtually never painful for an infant child. It may look uncomfortable, but because the bones are still soft and the child is not walking or bearing weight yet, they won’t feel a thing.
However, clubfoot will not get better without treatment, and if it isn’t corrected the consequences for your child as they learn to stand, walk, and grow can be severe. These can include painful arthritis, limited mobility (since the child may be walking on the side or even tops of their feet), inability to wear shoes, and other problems.
If clubfoot is treated successfully, though, the long-term prognosis is much improved. There may be some minor consequences; for example, if your child was born with clubfoot in only one leg, the foot might remain permanently smaller (up to 1.5 shoe sizes) than the other, and calf size and muscle strength might be affected as well. However, the vast majority of kids born with clubfoot are able to live fully healthy, active lives throughout adolescence and adulthood if they receive appropriate treatment.
Treatment for Clubfoot
Conservative and surgical methods exist to treat cases of clubfoot.
For the best long-term outlook, conservative treatments are strongly preferred, as surgery may leave the child with a stiffer foot. However, fixing clubfoot without surgery requires a long time and a high level of commitment from caregivers.
According to the Ponsetti method—the most common conservative treatment approach—the doctor will gently stretch the child’s foot into the correct position and hold it in place using a cast. For about two months, this process will be repeated every week. Afterward, there may be a small surgical procedure to release the Achilles tendon.
Once the clubfoot has been corrected, the child will need to wear special shoes and braces according to a strict schedule for up to 3 years in order to prevent the clubfoot from returning. The braces are usually needed nearly full time for the first several months, and only at night thereafter.
Surgery is held as a last resort when conservative treatment is not completely successful, often because the condition was especially severe, or (unfortunately) because parents or other caregivers are unable to fully follow the at-home portion of the treatment program. Even if some surgery is thought to be inevitable, it is still best to take conservative care as far as it will go first—even partial progress can mean that the eventual surgery can be less extensive and minimize long-term risk and complications.
At North Austin Foot & Ankle, we believe in the power of education. When it comes to clubfoot, understanding your responsibility as a parent is absolutely crucial in ensuring the best outcome for your child. If your newborn has a clubfoot deformity, please make an appointment with Dr. Keith McSpadden as soon as possible. Our team will make sure you have the information you need, the best treatment we can provide, and any referrals to other specialists as necessary. Please call today at (512) 593-2949.