What Is Clubfoot?

Clubfoot (Talipes equinovarus) is a congenital condition¹ (a condition that babies are born with). Clubfoot is a collection of anomalies in the ankle and foot due to the shortening of the Achilles tendon² (the big structure running at the back of the ankle).

Even though Clubfoot is not a serious condition, rarely it can be associated with other serious anomalies of the brain and spine.

In this article, you can find how common is clubfoot, causes, signs and symptoms, diagnosis, management, and FAQs about clubfoot.

Overview

Clubfoot, (Talipes equinovarus) is a condition of lower limbs that some babies are born with.³ The term ‘clubfoot’ encompasses a collection of anomalies of the foot and ankle of newborns. 1 in every 1000 babies born in the UK is affected by clubfoot and among them, half of the newborns have clubfoot in both feet.¹

Half of the infants with clubfoot present with clubfoot alone while the other half present with associated musculoskeletal abnormalities like neck deformities (torticollis), hip deformities (developmental dysplasia of the hip), and multiple joint abnormalities. Most of the time this is presented as isolated clubfoot. But in rare occasions, clubfoot can occur with other birth defects affecting the spine and brain (Spina bifida).⁴

Causes of clubfoot

There are no definitive causes for the occurrence of clubfoot. However, few causes have been identified as risk factors for clubfoot.

• Idiopathic clubfoot
• Familial/ genetic predisposition:
  • If a child has a clubfoot or feet, there is a 1 in 35 chance that the next sibling to be  born with a clubfoot/feet
  • If one parent has the condition, there is a 1 in 30 chance that the newborn will be born with the condition
  • If both parents have the condition, there is a 1 in 3 chance that it will be inherited
• Maternal smoking
• Very early amniocentesis⁵ (a special test offered during pregnancy)

In rare occasions, clubfoot can occur as a part of a syndrome (syndromic clubfoot) or as a result of neurogenic insult (neurogenic clubfoot).⁶ 

Signs and symptoms of clubfoot

A clubfoot occurs due to the shortening of the Achilles tendon. Due to this, the foot is pointed downwards and toward the body and the outer border of the foot is facing the ground.

Congenital clubfoot is usually painless unless it remained without correction.

Diagnosis of clubfoot

Clubfoot can be diagnosed during pregnancy (Prenatal) or after the child is born (Postnatal).^1,3

Prenatal identification of clubfoot can be done via ultrasound scan. However, clubfoot detected during the pregnancy via ultrasound should be confirmed postnatally by examining the newborn to diagnose it as a clubfoot. Prenatal detection helps carry  out other genetic tests to exclude anomalies associated with clubfoot.

Clubfoot is promptly diagnosed during newborn examinations. If clubfoot is diagnosed, other associated anomalies in the hips, neck, and spine are carefully looked at.

Management and treatment for clubfoot

Treatments for clubfoot start within the first 2 weeks after birth.

Treatment is always vital for clubfoot as this condition does not resolve by itself with the growth. The main treatment method is the Ponseti method which is the most accepted form of treatment for clubfoot worldwide, followed by the application of braces. The treatment  steps for  clubfoot are mentioned below.¹

• Ponseti technique: Stretching and manipulation

This non-surgical intervention entails careful stretching and manipulation of the foot to fix each component of clubfoot and holding the foot in the corrected position using a plaster cast. Plaster casts starting above the knee are used to keep the knee in the flexed/bent position to retain the foot/ feet in the corrected position. This process is then repeated weekly for up to 5 to 8 weeks to achieve the correct foot posture. 

• Ponseti technique: Achilles tendon release (Percutaneous Achilles tenotomy)⁷

After the last ponseti cast comes off, the majority of the babies (~95%) are required to undergo a small surgical procedure to release and lengthen the Achilles tendon. This procedure is done at the outpatient department under local anaesthesia, where the baby will be kept awake for the whole duration of time. Performing this step is pivotal for the full correction of the foot to  achieve the full range of ankle movements.

• Foot on a bar: Prevention of Clubfoot relapses

Following the correction, to prevent the relapse of clubfoot, the baby will be required to wear braces or boots-on-bar.⁸ These are sandals, which are open-toed and fixed into a bar in a way that the toes are faced away from the body. These sandals are required to be worn for three months full-time and then during the night until the age of five years. This step is vital to acquire a well-corrected foot/ feet.

FAQs

How is clubfoot diagnosed

Clubfoot is usually diagnosed during the newborn examination. However, sometimes this can be visualized via ultrasound scans done during the pregnancy, which should be confirmed during the newborn examination.

How can I prevent clubfoot in my baby

The majority of clubfoot cases are idiopathic. However, familial clubfoot is seen with a genetic predisposition.

A link between clubfoot and maternal smoking has been revealed and occurring clubfoot due to this factor can be prevented by the cessation of smoking.

Who are at risks of clubfoot

If a baby is born with clubfoot/ feet the next baby born to those parents has a 1 in 35 chance to be born with clubfoot/ feet.

If one parent had a clubfoot at birth, there is a 1 in 30 chance that the baby will be born with clubfoot.

If both parents had clubfoot at birth, the chance of their baby having a clubfoot increased up to 1 in 3.

How common is clubfoot

Every 1 in 1000 babies born in the UK has clubfoot. Boys are more prone to this condition than girls.

Among them, half of the babies are born with bilateral clubfoot.

When should I see a doctor

Usually, clubfoot is diagnosed during the newborn examination. However, if you notice clubfoot in your child consult a doctor in the first instance as the correction should be done during the early stage for a better outcome.

Can my baby have more ponseti castings instead of Achilles tenotomy

No, in order to achieve a full range of ankle movements with complete correction of the foot, Achilles tenotomy is vital. This cannot be replaced by further castings.

Summary

Clubfoot is a congenital condition affecting the ankle and foot of newborns. This condition is rarely associated with other serious conditions like ‘spina bifida’. The chance of getting clubfoot is 1 in 1000 among newborn babies. The possibility rises if older siblings or parents had clubfoot in childhood. Diagnosis usually takes place during the newborn examination.

The mainstay of treatment is the Ponseti technique, which involves gentle manipulation and applying braces to keep the foot in the corrected position.