Clubfoot in children

What is clubfoot?

Clubfoot, also called talipes equinovarus, is a relatively common birth issue, happening in about one in 1,000 births. It is more common in boys than girls. About half the time, it affects both feet.

The condition, while complex, is treatable and can have a very functional outcome.

What causes clubfoot?

No direct cause has been found. The issue starts when a woman is about nine weeks pregnant. There is an increased risk in boys and with some inherited syndromes, so genetics can play a role. Most often, there is no clear cause — no other family members with clubfoot — and the baby is otherwise perfect.

Clubfoot can be associated with other conditions or syndromes, such as spina bifida, Ehlers-Danlos syndrome or osteogenesis imperfecta. But if a child has no obvious signs or family history of these problems, there’s no reason to be concerned.

Treatments

Treatment begins in early infancy. If your child with clubfoot has other health issues, the general health and well-being of your child should be addressed first. We are not advocates of starting orthopedic clubfoot treatment while your baby is still in the hospital nursery or NICU. However, therapists, nurses and parents may be encouraged to stretch the feet by hand during this time. We do encourage early referral to Norton Children’s Orthopedics of Louisville for treatment to begin.

Treatment always involves casting of the foot. We follow the techniques pioneered by Ignacio Ponseti, M.D. The provider does not “break” the foot. We gently stretch the foot into the best gently corrected position possible and place it in a cast to hold the position. The cast is left in place for a week and replaced after additional stretching.

The casting continues weekly until the foot is adequately corrected in rotation. Most of the time, the toes are still pointed down but the remainder of the issue is corrected. Most feet can be corrected with between four and six casts, but sometimes more are needed.

Once optimal correction is achieved, if the toes are still pointed down (which is usually the case), your baby will have a heel cord lengthening. At Norton Children’s Orthopedics of Louisville, surgery is done in the operating room with an anesthesiologist present. Another cast is placed while your baby is asleep. This cast must stay in place for three to four weeks.

At this point, the foot should be completely corrected. Taking care of the feet will be important during your child’s entire life.

Maintenance

After clubfoot is corrected, if it is not taken care of in the right way, it can become an issue again. Wearing a brace can provide the best upkeep for kids with clubfoot. The brace holds the ankles in a neutral position (at 90 degrees to the shin bone) but keeps them from turning back in toward each other.

The brace must be worn consistently for the best possible outcome. Your provider will give you specific instructions, but as a general rule, the brace is worn nearly all day and night initially. By the time your child is ready to walk, it is transitioned to 12 to 16 hours every day. Clubfoot has been shown to return when a child does not consistently wear a brace. For this reason, if your child has problems with the brace, every effort should be made to overcome the issue.

The risk of clubfoot returning falls as your child ages. If your child’s foot begins turning in again before kindergarten, there often is a small surgery recommended to help stop that progress. If the foot is still stiff and causing difficulty with shoe wear after age 8, a larger surgical procedure may be needed.

Your child can expect to walk normally and can play sports after treatment. In most cases, the affected foot will be smaller and thinner throughout life. Even the calf will be smaller and thinner, and occasionally even shorter than the other side. Sometimes the size discrepancy may require a different size shoe on each foot. A prescription shoe insert might allow the same size to be worn on both feet.

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