Clubfoot is a birth defect that causes the newborn’s foot or feet to appear twisted at the ankle. If your child has clubbed feet, it is very challenging for your child to walk normally. Hence doctors recommend that clubfoot treatment start immediately after birth.
However, the lack of public knowledge about club foot can delay treatment. It can cause severe deformities as the child grows and puts weight on the foot.
We have spoken to the medical experts at Hera to bring you all the information about club foot in children.
Club foot is a developmental disorder of the lower limb that is present at birth. This complex condition occurs when the tissues connecting the muscles to the bone are shorter than usual. This makes your baby’s foot twist out of the normal position – usually inwards with the toes pointing down.
The medical term for this congenital defect is Talipes Equinovarus, and it occurs in one to two per 1000 live births. Clubfoot may affect one or both feet, a condition known as bilateral club foot. It is more common in males than in females.
Clubfoot is classified into two major groups – congenital and acquired.
The congenital Clubfoot is further classified into idiopathic and non-idiopathic types.
This is the most common form of the deformity and occurs in children who have no other medical problems. It is typically an isolated skeletal anomaly, occurs in both feet and has a higher response rate to conservative Clubfoot treatment. There is also a tendency towards a late recurrence.
It is also called Syndromic clubfoot. Syndromic clubfoot occurs when the condition is part of a larger syndrome. It is more severe and difficult to treat.
This is caused by conditions of the nervous system (neurogenic) such as Poliomyelitis, Meningitis, Sciatic Nerve Damage and Vascular causes (Volkmann Ischemic Paralysis).
Clubfoot is diagnosed in pregnancy with an ultrasound at around 18-20 weeks of gestation. However, this is only 80% accurate.
After the birth of your baby, the doctor can also diagnose club foot by visually inspecting the newborn’s foot. This is usually followed by an X-ray of the foot to assess the position and determine the severity of the abnormalities. As a third step of diagnosis, the doctor will order a complete physical examination to rule out other spinal and muscular diseases.
Clubfoot Treatment cannot be done before birth. But a diagnosis during pregnancy will help your doctor prepare an early treatment plan.
Over the years, many conservative and surgical approaches for clubfoot treatment evolved with varying levels of success. There are four main options for clubfoot treatment include –
Dr Kite developed the Kite method for clubfoot treatment in the USA in the 1930s. It involves a series of manipulations that start soon after birth. The castings move in sequence, starting with the forefoot adduction, followed by the hindfoot varus, and finally the ankle equinus.
Ignacio Ponseti developed this method of clubfoot treatment in the 1940–1950s. It involves a careful stretching and manipulation of the foot and holding with a cast.
The first cast is applied one or two weeks after the baby is born and is changed every seven to 10 days. With the fourth or fifth cast, the doctor may use a local numbing medicine and small blade to perform a small in-office procedure to lengthen the Achilles tendon. This is followed by a last cast, which remains on for two to three weeks.
During the maintenance phase, the family members are taught foot stretching exercises. The infant’s foot is placed in a removable orthotic device that is to be worn 23 hours per day for three months and then at night until five years of age.
In recent times, the Ponseti technique has gained widespread acceptance as the preferred clubfoot treatment.
Masse and Bensahel introduced this technique in France in the 1970s. It is also known as the Functional technique. It involves a daily manipulation of the child’s club foot by the physical therapist for 30 minutes. This is followed by applying adhesive tape to your child’s club foot, instead of a cast. Your doctor will probably continue this treatment until your child is six months old. After this, he will be given a below-the-knee Aquaplast splint until 2 or 3 years of age to prevent a recurrence.
If your child’s club foot doesn’t respond to manual manipulation or if it is severe, surgery may be necessary to correct the club foot and to bring it into alignment. After surgery, your child will have to wear a cast for a while to maintain the correction.
Children with clubbed feet struggle with balance, coordination, gross motor function, strength and agility. After treatment, the most common complication is recurrence which is difficult to correct. This is why regular monitoring is recommended until the person reaches adulthood.
Left untreated, club foot can cause many complications from mobility issues, long-term risk of eventually developing arthritis to self-esteem problems due to the unusual appearance of the feet. Sometimes, even after clubfoot treatment, one foot will be smaller than the other foot, and less mobile.
Babies with clubbed feet can sometimes have a complication called developmental dysplasia of the hip (DDH). Here, the socket of the thigh bone is too shallow, causing the thigh bone to slip in and out of the socket.
Clubfoot is the most common congenital disorder of the legs that can range from mild to severe. However, correct treatment can improve the appearance and function of the affected foot.
Your doctor will advise you on the most appropriate treatment or specialist for treatment based on the age of your child and the severity of the condition Some doctors you will come across in your treatment journey are –
Pediatricians have a critical role in the early detection of club foot. From starting the initial evaluations of the newborn and the prompt referral to a specialist to supporting the family during the brace-phase.
A consulting doctor is a senior doctor with a specialty who can advise, supervise and guide the treatment process.
A physiotherapist can help with exercises and manipulations of the foot to improve the motor development of the child.
A pediatric orthopedic surgeon is a doctor for children with musculoskeletal problems who will help with the surgical correction of your child’s clubbed feet.
Parents of children with clubfoot may feel anxious about the future of their child. However, with proper treatment and in due time, their child will use their foot and live a normal life without major difficulty.