Clubfoot

What is clubfoot in children?

Clubfoot is a deformity of the foot. It’s when one or both feet are turned inward. The condition affects the bones, muscles, tendons, and blood vessels. Clubfoot is present at birth. It tends to affect more boys than girls.

What causes clubfoot in a child?

A combination of things may lead to clubfoot. It is partly genetic. This means it tends to run in families. It may also be environmental.

Which children are at risk for clubfoot?

A child with a family history of clubfoot is more likely to develop it. Other risk factors are:

• Multiple births such as twins or triplets
• Position of the baby in the uterus
• Nervous system disorders such as cerebral palsy and spina bifida
• Less amniotic fluid surrounding the baby in the uterus (oligohydramnios) during pregnancy

Babies born with clubfoot may also have a higher risk for developmental dysplasia of the hip (DDH). This health problem affects the hip joint. The top of the thighbone (femur) slips in and out of the hip socket because the socket is too shallow.

What are the symptoms of clubfoot in a child?

The symptoms of clubfoot are:

• The foot is usually short and broad in appearance.
• The heel points downward while the front half of the foot (forefoot) turns inward.
• The heel cord (Achilles tendon) is tight.
• The heel can appear narrow.
• The calf muscles are smaller compared with a normal lower leg.

How is clubfoot diagnosed in a child?

Your child’s healthcare provider makes the diagnosis of clubfoot at birth with a physical exam. During the exam, your child’s healthcare provider may ask about your child’s birth history and if other family members are known to have clubfoot.

If the diagnosis of clubfoot is made in an older infant or child, your child’s healthcare provider may ask about developmental milestones. Clubfoot can be linked to other disorders. Developmental delays may need more follow-up to look at an underlying problem.

Your child may also need X-rays.

How is clubfoot treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

The goal of treatment is to straighten the foot so that it can grow and develop more normally. Without treatment, your child would have trouble walking. Treatment choices include:

• Nonsurgery treatments. These are usually tried first no matter how severe the deformity is. The most common treatment in the U.S. is the Ponseti method. It uses gentle stretching and a cast to gradually fix clubfoot. It often takes about 2 to 3 months. Other methods include taping, physical therapy, and splinting.
• Braces. Because clubfoot may happen again, your child will have to wear braces for several years to prevent relapse. At first, the braces are worn for 23 hours a day for up to 3 months. Then they are worn at night for 2 to 4 years.
• Surgery. Your child may need surgery if other treatments don't fix clubfoot. The specific surgery depends on the type and extent of the deformity. Your child may need surgical wires, pins, or a cast to keep the foot in place until it has healed.

Most infants with clubfoot don’t need surgery. Those who do may need more than one surgery because the deformity may come back as the child grows and develops.

Key points about clubfoot in children

• Clubfoot is a deformity of the foot and lower leg. It’s when one or both feet are turned inward.
• Children with a family history of the condition are more likely to be born with it.
• Clubfoot causes the heel to point downward while the front half of the foot (forefoot) turns inward. The foot is usually short and broad in appearance.
• Most cases of clubfoot are diagnosed at birth.
• Treatment includes stretching and casting. Your child may need surgery if other methods don’t work.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Online Medical Reviewers:

• Raymond Kent Turley BSN MSN RN
• Thomas N Joseph MD