Clubfoot, the most common foot defect

Donya Betancourt, Pediatrician, Sanur, drdonya@hotmail.com

After discussing in-toeing and out-toeing last week, we will now talk about clubfoot, the most common foot defect.

Clubfoot affects about one in every 1,000 newborns.

You will immediately know if your baby has clubfoot as it is present at birth.

Clubfoot affects your child's foot and ankle, with changes in bone, skin, tendons and ligaments such as the twisting of the heel and inward turning toes. It may look like the top of the foot is on the bottom. The clubfoot, calf and leg are smaller and shorter than normal. The medical term for clubfoot is congenital talipes equinovarus (CTEV). "Congenital" means before or at birth. "Talipes," literally "ankle-foot", refers to the talus. "Equinovarus" refers to the position of the clubfoot, the foot is curved inward (varus), down (equinus) and has a "C" or bean shape (metatarsus adductus). In about half of the cases only one foot is involved.

Clubfoot is not painful, is correctable and the baby is likely to be otherwise normal.

The cause of the condition has been carefully studied, but no one knows why it happens. What we do know is that there are genetic factors (more important) and environmental factors (less important). There is a tendency for clubfoot to run in families. A baby born to a parent with clubfeet has a 1:10 chance of inheriting the disorder.

The condition varies in severity from mild, which is correctable by the examiner, to severe, in which the deformity is rigid. If not treated, the deformity will persist and the child will eventually walk on the side or top of the foot, he or she will have a severe functioning disability.

With treatment, a child should have a nearly normal foot so treatment should begin as soon as possible after birth.

Early treatment consists of casting to correct the deformity. A new cast is applied and physical therapy is done, and one week later it is done all over again. In the first month or two this is usually done weekly, followed by every other week as the rapid growth of an infant decelerates. This process (serial casting) slowly moves the bones in the clubfoot into proper alignment.

Casting is generally repeated for six to 12 weeks, and may take up to four months. In mild cases, casting may completely correct the deformity. About half the time, a child's clubfoot straightens with casting. If it does, he or she is fitted with special shoes or braces to keep the foot straight once corrected. These holding devices are usually needed until the child has been walking for up to a year or more. When persistent deformity is not corrected by manipulation and casting, surgery is usually required. This is usually done when a child is six to 12 months old.

Even though surgery corrects all clubfoot deformities in a baby, at the same time it is possible for the muscles in the child's foot to try to return to the clubfoot position, and special shoes or braces will likely be used for up to a year or more after surgery. It is possible that the baby will not need another operation.

Parents always ask if their child will walk normally. Successful treatment means a child will be able to participate in all activities he or she wishes to. Some famous athletes were born with clubfeet, and though CTEV sometimes recurs, it can be treated again quite successfully.

However, a corrected clubfoot will still not be perfect. After treatment, a patient usually has a slightly smaller foot and calf on the affected side, but this does not affect a child's use of his or her feet. The affected foot will be somewhat less mobile than the normal foot. Remember, if you have any questions or concerns during your child's treatment, please ask your pediatrician, who will be happy to provide answers.