Clubfoot: Symptoms, Causes & Treatment

Clubfoot/CTEV is a congenital (present at birth) condition in which your baby’s foot or feet turn inward. It won’t go away on its own, but with early treatment, children experience good results. Approximately 1 in every 1,000 babies will be born with clubfoot, which makes it one of the more common congenital foot deformities.

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.

What is clubfoot?

Clubfoot happens because of an issue with your child’s tendons, the tissues that connect muscle to bone. The tendons in your baby’s leg and foot are shorter and tighter than they should be. That causes the foot to twist. About half (50%) of babies with clubfoot have an issue with both feet.

Initially, extensive surgery was the only treatment for correcting clubfoot. But today, doctors typically use a combination of nonsurgical methods and a minor procedure.

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 of clubfoot 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 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: commonly seen are

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 than those on the unaffected leg. This is due to reduced use of the affected foot during normal movement and growth.
If untreated, these clinical features of CTEV can affect walking, 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:

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

Who is at risk for congenital clubfoot?

Baby boys are up to twice as likely to develop clubfoot as baby girls. A family history of clubfoot also puts your baby at a higher risk.

Babies are also at a higher risk if they have:

• Another birth defect, like spina bifida or cerebral palsy.
• A genetic condition, such as Trisomy 18 (Edward syndrome).
• Mother had oligohydramnios during pregnancy. This is a problem of not having enough amniotic fluid, the fluid that surrounds the fetus.
• Had Zika infection during pregnancy, which can lead to birth defects and other issues.
• Smoked, drank alcohol or used recreational drugs during pregnancy.

How does clubfoot affect my baby?

Clubfoot isn’t painful for your baby. Many babies won’t even notice it during the first few months of life. But clubfoot will get in the way of standing and walking. It won’t go away on its own. Babies with clubfoot need treatment to correct the problem before they reach walking age.

Untreated clubfoot can lead to:

• Walking problems. Babies with clubfoot often walk in unusual ways. Typically, people walk on the bottoms and soles of their feet. A baby with clubfoot may walk on the sides and tops of their feet.
• Foot infections.
• Foot problems, including calluses. A callus is a thick layer of skin that often develops on the sole of the foot.
• Arthritis, a joint condition that causes pain, stiffness and swelling.

Diagnosis and Tests

When and how is clubfoot diagnosed?

Many times, doctor notices clubfoot when you’re having an ultrasound during pregnancy. A prenatal ultrasound shows pictures of the developing fetus. If your doctor diagnoses clubfoot during pregnancy, you can start planning for the treatment your child will need after birth.

Other times, your doctor may diagnose clubfoot after your baby is born. They’ll usually notice it during one of your baby’s first physical exams. In some cases, your doctor may recommend an X-ray to confirm the diagnosis.

Management and Treatment

When should clubfoot treatment start?

Doctors recommend treating clubfoot as soon as possible. Early treatment helps your child avoid problems later. It’s best to begin treatment during your baby’s first two weeks of life.

Who treats clubfoot?

Your baby will likely need a team of healthcare professional to treat clubfoot, including

• Orthopaedic surgeon: Specialises in surgery for bones and joints.
• Physical therapist: Helps your child build strength and move their foot.

How is clubfoot treated?

Clubfoot treatment includes several methods. Your care team will discuss the options with you and figure out which works best for your child. Treatments include:

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 correct position of the foot.

Ponseti method of Casting

The Ponseti method is the most popular treatment method involving serial casting. It lasts about two to three months. Your care team will start this therapy within the first two weeks after birth.

An orthopaedic surgeon performs this method. They’ll:

• 1. Stretch your baby’s foot toward the correct position.
• 2. Put their foot in a cast, which starts at their toes and goes all the way to their upper thigh.
• 3. Repeat this process every four to seven days with a new cast. Each time, the surgeon moves their foot a little closer to the correct position.

Before the final cast, the surgeon typically performs an Achilles tenotomy –

• 1. Cut your baby’s heel cord (Achilles tendon) in a quick procedure. This tendon connects their heel to their calf muscles. The cut is small and won’t need stitches.
• 2. Put on a new cast as their tendon heals, which takes about three weeks.

The goal of this surgery is to allow the tendon to grow to a typical length. When the last cast comes off when, the tendon reaches a regular length. As your baby recovers, they may need to:

• Do stretching exercises so their feet stay in the correct position.
• Wear special shoes or a foot brace for a few years.

Bracing

Your care team may recommend bracing after your baby has finished the Ponseti method. Even if those treatments work, your baby’s foot can move back to the incorrect position. A brace keeps the foot at the correct angle so it doesn’t move out of position. The brace is usually a pair of shoes with a metal bar connecting them. The brace is often called “boots and bar.” It’s important to:

• Have your child wear the brace every day for three months, then only at night or naps for typically four years.
• Follow the instructions carefully. If your child doesn’t wear the braces when they’re supposed to, their foot may return to the clubfoot position again.

There are several types of braces. Your provider will discuss your options so you can find the right brace for your child.

Surgical Management

Sometimes, a child has severe clubfoot. Or you’ve tried nonsurgical methods, but they haven’t worked. Surgery can correct the problem. It’s best if your child has the surgery before they start walking. During the procedure, the surgeon:

• 1. Lengthens your baby’s heel cord and fixes other problems with their foot or feet.
• 2. Place pins in their foot to correct the position.
• 3. Puts a cast on their foot after the surgery.

A few weeks after the surgery, the surgeon:

• 1. Removes the cast and pins.
• 2. Puts a new cast on your child’s foot, which your child wears for about another four weeks.
• 3. Removes the final cast.

There’s still a chance their foot could return to the clubfoot position. Your doctor may recommend bracing or special shoes to keep their foot in the correct position.

What are the risks of clubfoot surgery?

Risks of congenital clubfoot surgery include:

• Nerve injury.
• Infection.
• Bleeding.
• Stiffness.

Prevention

Can clubfoot be prevented?

Good healthcare before and during pregnancy gives your child the best chance for a healthy start in life. If you’re at high risk for having a baby with clubfoot or other birth defects, talk to a genetic doctor. A genetic doctor is an expert in birth defects and genetic conditions.

When you’re pregnant:

• Make sure to go to all your prenatal care appointments.
• Don’t smoke or drink alcohol, and only use medications approved by your doctor.

Prognosis

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.

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.

Can clubfoot return?

Clubfoot can come back. It’s more likely to happen if the treatment schedule wasn’t followed correctly. If the foot returns to the clubfoot position, see your child’s healthcare provider. They can advise you on the next steps. You may need to repeat some stages of the treatment plan.

How can I help my child with their brace?

Regularly wearing the brace gives your child the best chances for success. However, it can be challenging for children to wear the brace for hours daily. These tips can help parents ease the process of brace-wearing:

• Make it fun: Play with your child when they’re wearing their brace. Do gentle exercises and kicking games. Use the bar to help bend and straighten their knees.
• Make it routine: After the first three months, your child will only need the brace during night-time and naps. Make the brace part of their sleeping routine. They’ll understand that going to sleep means wearing the brace.
• Add a pad: A soft pad on the metal bar makes the brace more comfortable for your child and yourself. It also has the benefit of protecting furniture and appliances in your house.
• Prevent slippage: Sometimes, the foot keeps slipping out of the brace. Make sure the strap is tight. Double socks may also help keep the shoe firmly on the foot. A physical therapist can recommend other steps to make sure the shoe is snug on the foot.

Conclusion

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.

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.

A note from SPARSH Hospital Foot-ankle and Sports Injury Head Dr Vijay Kumar D

As a parent, when you see that the fetus, or your newborn, has something unexpected, you may wonder about the next steps. You’ve waited for your entire pregnancy thinking about the cute outfits you’d put your baby in — not the casts, splints or braces they’d have to wear. But clubfoot is a common birth defect and treatment is very successful. It’s important to follow the treatment schedule carefully. Doing so increases the chances of success. With the right treatment, many children with clubfoot can walk, run and even play sports without pain. Talk to your child’s doctor about the best therapy method for your child’s clubfoot.

Care at SPARSH Hospital

Clubfoot is a treatable condition that can have a significant impact on a child’s mobility and quality of life. Foot-ankle and sports injury head Dr Vijay Kumar D will provide world-class treatment for your child’s condition, including early diagnosis, Manipulation and Casting, Surgery as well as post-operative Physiotherapy.

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.