Clubfoot

1 What is Clubfoot?

Clubfoot refers to a group of painless congenital (at birth) foot deformities in which your baby's foot may be rotated to give an appearance similar to head of a golf club, hence the name club foot.

Almost half of the children with clubfoot have both of the feet affected. Having clubfoot will make it difficult for your child to walk normally.

Treatment should be initiated soon after birth. A follow-up surgery may be required in few cases. 

2 Symptoms

Child with clubfoot shows following symptoms:

  • The top of foot is twisted downward and inward
  • The heel is pointed inward
  • Undeveloped calf muscle of affected foot
  • Normal foot is about half inch bigger than the affected foot

Clubfoot causes no discomfort or pain.

When to see a doctor?

Your doctor will most probably notice your child's clubfoot almost immediately after birth. Your doctor will advise suitable treatment for your child.

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3 Causes

The cause of clubfoot has not been identified yet. But it is certain that the position of fetus is not responsible for causing clubfoot.

In few cases, a child with congenital abnormalities of skeleton, such as spina bifida (a serious condition in which underdeveloped spine is can't cover spinal cord completely) may have clubfoot.

Clubfoot might be caused by environmental factor.

Smoking during pregnancy, particularly when there is history of clubfoot in the family, is associated with higher risk of having clubfoot.  

4 Making a Diagnosis

In most cases, your baby's clubfoot is diagnosed immediately after birth. Your baby's doctor might recommend you to visit a pediatric orthopedist (a child's doctor who treats bone and muscle disorders).

You may ask following questions to your child's doctor

  • What are the types of corrective treatments for my child's condition?
  • Its surgery necessary for my child?
  • Can my child have a complete recovery and a normal gait?
  • Do you have a family history of clubfoot?
  • Have you had any health problems when you were pregnant?

Your doctor may order X-rays even when the diagnosis is confirmed. An X-ray image will be helpful in determining the severity of the condition.

Your baby's clubfoot might be diagnosed before birth during ultrasound examination. Knowing that your child will have club foot can give you time to learn more about clubfoot and take appropriate treatment decisions.

The treatment starts once your child is born.

5 Treatment

Treatment for clubfoot normally starts when your child is a week or two weeks olds. The treatment is aimed at improving the appearance of your child's foot and preventing disabilities. Here are some treatment options for club foot:

  • Ponseti method: It is the most commonly used treatment for clubfoot. It involves stretching the affected foot and repositioning it in the correct position by using a cast. This process is repeated once or twice a week for some months. Afterwards, a minor surgery is performed to stretch the tightened Achilles tendon. You may do the following to maintain the correct foot position in your baby:
      • Stretch the foot often to maintain correct position
      • Use special shoes and braces for three months. The braces can't be removed during this period. Then, the braces need to be worn at night for about three years.

Strictly follow your doctor's direction while applying the braces to prevent the foot from returning to its original position. This treatment procedure is likely to be unsuccessful if the braces are not used continually.

  • French method: French method, also known as the functional method or physiotherapy method, involves stretching and taping the foot. The foot is gently stretched followed by taping so that the foot is maintained in correct position. The baby's foot, while s/he is sleeping, is kept into a machine where it is constantly moved. These procedures are performed daily till your baby turns two months, thenafter you need to take your baby to the doctor thrice a week untils he is 6 months old. Afterwards, continuous daily exercise is necessary. Splinting during night until the baby starts walking is essential. This treatment method requires more time than Ponseti method.
  • Surgery: Surgery is opted if clubfoot is severe or unresponsive to non-surgical methods. The tendons that are responsible for the clubfoot are released and elongated, which helps to bring the foot into correct position. The foot is kept in a cast for about two months. After removal of cast, your child should wear braces for about a year. Braces are worn to prevent the recurrence of clubfoot.

Clubfoot may not be cured completely. But in most of the cases, the babies when treated early can wear normal shoes and live a normal life.

6 Prevention

Clubfoot can't be prevented but the risks can be reduced.

If you are pregnant, don’t:

  • smoke or avoid smoky environments
  • drink alcohol
  • take drugs which are not approved by your doctor

7 Risks and Complications

There are several risks and complications associated with clubfoot.

Risks

  • Sex: Clubfoot is more likely to occur in males.
  • Family history: If anyone among your family has clubfoot, the baby is at increased risk of having it. Likewise, if your baby has another birth defect, s/he is likely to have clubfoot.
  • Smoking during pregnancy: If you have a family history of clubfoot and smoke during pregnancy, your baby is 20 times more likely to develop clubfoot.
  • Insufficient amniotic fluid during pregnancy: Having insufficient fluid that surrounds the baby in the womb can increase risk of clubfoot.
  • Getting an infection or using illicit drugs during pregnancy: The likelihood of having clubfoot increases if the mother gets infected or uses unsafe drugs during pregnancy.
  • Clubfoot usually doesn't cause any problems. If treated early, your child might be able to walk rather normally. Some of the difficulties your baby is likely to face are:
      • Mobility: Your child's mobility can be limited.
      • Shoe size: The size of unaffected foot is slightly bigger than that of affected foot.

Complications

  • Poor self-image: Unusual appearance of the foot might affect your child’s self-image.
  • Inability to walk normally: Your child will not be able to walk normally. Walking on the soles is impossible, so your child may walk on top of the feet.
  • Muscle development problems: Since your child cannot walk normally, it may affect development of calf muscles, cause large sores or calluses on the feet.
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