Clubfoot: Symptoms, Causes & Treatment

Clubfoot, also known as CTEV (Congenital Talipes Equinovarus), is a common congenital deformity where a baby’s foot appears twisted or turned inward. It can affect one or both feet. Early treatment, such as the Ponseti method, can correct the condition and help the child lead a normal life.

Understanding Clubfoot

Clubfoot is a congenital deformity of the foot that occurs in infants. It causes the foot to twist inward or downward, making walking or wearing shoes challenging if left untreated. While it can affect one foot (unilateral), it often impacts both feet (bilateral).

The condition is not painful for newborns but can cause significant issues with mobility as they grow older. Early diagnosis and treatment are crucial for correcting the condition.

CTEV stands for  Congenital Talipes Equinovarus, where:

• Congenital means present at birth.
• Talipes refers to the ankle and foot.
• Equinovarus describes the inward and downward turning of the foot.

Types of Clubfoot

The types of clubfoot are generally classified based on severity and the underlying cause:

Idiopathic Clubfoot

This is the most common type of clubfoot, occurring without any underlying medical condition or known cause. While the exact cause is unclear, genetics may play a role.

Neurogenic Clubfoot

This type is linked to neurological disorders, such as spina bifida or cerebral palsy, which affect nerve and muscle function. Neurogenic clubfoot arises due to imbalances in muscle tone or movement caused by these conditions, often making it more complex to treat.

Syndromic Clubfoot

Syndromic clubfoot occurs as part of genetic syndromes like arthrogryposis or Larsen syndrome. These conditions usually involve multiple joint abnormalities, making the clubfoot more rigid and challenging to correct.

Positional Clubfoot

This type results from restricted movement in the womb, often due to limited space or abnormal positioning during pregnancy. Positional clubfoot is typically less severe and can often be corrected with gentle stretching or minor interventions.

Symptoms of Clubfoot

The symptoms of clubfoot are easily recognisable at birth or during prenatal ultrasounds:

Twisted Foot Appearance

In cases of clubfoot, the foot is visibly twisted or rotated. The sole of the foot may face inward or upward rather than downward, creating an abnormal appearance. This twist often makes it impossible for the foot to rest flat on the ground.

Abnormal Shape

The affected foot is usually smaller than normal. The heel may appear narrower, and the arch may look exaggerated or absent altogether. This unusual shape contributes to difficulties with balance and mobility.

Stiffness

The foot and ankle often lose flexibility due to the tightening of tendons and ligaments. This stiffness can make it hard or impossible to move the foot into a normal position without medical intervention.

Shortened Achilles Tendon

The Achilles tendon, located at the back of the heel, is frequently shortened and tight in children with clubfoot. This contributes to the downward pointing of the foot and limits range of motion.

Affected Calf Muscles

The calf muscles on the affected side may be underdeveloped or smaller in size compared to the unaffected leg. This is a result of reduced use of the affected foot during normal movement and growth.

These clinical features of CTEV can affect walking if untreated, causing the child to walk on the sides or tops of their feet.

What Causes Clubfoot?

The club foot causes are not entirely understood, but several factors may contribute:

1. Genetics: Family history plays a significant role, with a higher likelihood of clubfoot in families with a history of the condition.
2. Environmental Factors: Smoking, drug use, or certain infections during pregnancy can increase the risk.
3. Neurological Disorders: Conditions like spina bifida or cerebral palsy may result in secondary clubfoot.
4. Intrauterine Positioning: Restricted movement of the baby in the womb can affect foot development.

Club Foot Treatment Options

Treatment for clubfoot begins as early as possible, typically within the first weeks of life.

1. Ponseti Method

This is the gold standard for treating clubfoot disorder. It involves:

• Manipulation and Casting: The foot is gently manipulated into the correct position and held with a cast. This process is repeated weekly for 6–8 weeks.
• Achilles Tenotomy: A minor surgical procedure to release the tight Achilles tendon.
• Bracing: After correction, the child wears a special brace to prevent relapse.

2. French Functional Method

This method involves daily stretching, massage, and taping by a physiotherapist, gradually correcting the foot’s position.

3. Surgery

In severe or neglected cases, surgical intervention may be required. Surgery involves releasing and lengthening tight tendons and ligaments to correct the deformity.

4. Physical Therapy

Ongoing physiotherapy strengthens the muscles and improves the range of motion in the affected foot.

5. Orthotics

Customised orthotic devices, like braces, are used to maintain the corrected position of the foot.

When to See a Doctor?

Early intervention is crucial for correcting clubfoot effectively. Parents should consult an orthopaedic doctor if they notice:

• Twisted or abnormally shaped feet at birth.
• Difficulty in movement or flexibility of the foot.
• Delayed milestones like standing or walking.

If you want to consult the best paediatric orthopaedic doctor in Bangalore, you can visit SPARSH. Our expert orthopaedic doctors excel in paediatric care and ensure timely diagnosis and expert care, giving your child the best chance of leading a normal, active life.

Conclusion

Clubfoot is a treatable condition that can have a significant impact on a child’s mobility and quality of life if left unaddressed. Early diagnosis, appropriate treatment, and ongoing care are essential for effective correction and relapse prevention. With advanced treatment options like the Ponseti method, most children can lead active, healthy lives.

Frequently Asked Questions

What is the main cause of clubfoot?

The primary cause of clubfoot is often genetic. Environmental factors and neurological conditions may also play a role.

Does club foot go away?

With proper treatment, such as the Ponseti method, clubfoot can be corrected, although follow-up care is necessary to prevent relapse.

Can a clubfoot be corrected?

Yes, clubfoot can be corrected through early treatment involving manipulation, casting, and bracing. In severe cases, surgery may be required.