All about clubfoot in children

Clubfoot is a birth condition that affects the bones, muscles, tendons, and blood vessels of the foot. The forefoot of the foot curves inward while the heel points downward. Under extreme conditions, the foot is rotated to the point where the bottom of the foot faces up or laterally rather than down.

Many parents discover that their child has clubfoot during a prenatal ultrasound months or weeks before birth. Once the infant is delivered, the problem is readily apparent. Ideally, treatment should begin within a child’s first month of life.

The good news is that the vast majority of children with clubfoot who receive early treatment can run, play, and function normally. Without therapy, however, clubfoot will not improve. The foot will remain in the malformed posture, making it difficult for your child to walk.

What symptoms accompany clubfoot?

If only one foot is afflicted:

• The calf muscle on the affected leg is smaller than on the other leg.
• The affected leg is frequently shorter than the unaffected leg.
• The affected foot may be short and wide.

Who is susceptible to acquiring clubfoot?

Most children with clubfoot do not inherit the affliction from their parents. However, having an older sibling with clubfoot raises the likelihood that a kid may be born with the ailment.

• If a boy has clubfoot, his next-born sibling has a 2.5% risk of inheriting the condition.
• If a girl has clubfoot, her next-born sibling has a 6.5% risk of being born with clubfoot.

Additional risk elements include:

• Masculine gender; males are twice as likely as girls to be born with clubfoot.
• Neuromuscular diseases, including cerebral palsy (CP) and spina bifida
• Congenital anomalies including arthrogryposis and amniotic band syndrome
• Oligohydramnios (a reduction in the amount of amniotic fluid around the foetus in the uterus during pregnancy)
• Breech birth (the foetus being delivered bottom-first rather than head-first)

Babies born with clubfoot may also be more likely to acquire developmental dysplasia of the hip (DDH). In DDH, the femur slips in and out of its socket because the socket is too shallow to maintain the integrity of the joint.

What causes clubfoot?

Most clubfeet are idiopathic, meaning that doctors are uncertain as to their cause. Clubfoot is most likely inherited and runs in families. However, researchers do not yet know which gene or genes are responsible.

Tightness of the muscles and tendons surrounding the foot and ankle keep the foot in its distinctive downward and inward posture in all children with clubfoot. This tightness may be caused by variations in blood circulation or nerve signal reception in the affected legs. Other hypotheses about the aetiology of clubfeet include problems in the development of the bones, tendons, or muscles, as well as a mechanical obstruction in utero. However, these theories remain unverified.

In some instances, clubfoot is a symptom of a condition or congenital abnormality. In other instances, the foot was positioned awkwardly in the womb. However, most children are born with clubfoot for unknown reasons.

How is clubfoot diagnosed and treated?

Typically, clubfoot is detected during a prenatal ultrasound before a child is born. About 10% of clubfeet can be detected as early as 13 weeks into pregnancy, while about 80% of clubfeet can be diagnosed by 24 weeks.

If a child is not diagnosed prior to delivery, clubfoot might be seen and diagnosed at birth. Generally, a physical examination is sufficient to establish a diagnosis. In rare instances, additional testing, including:

• X-ray
• Computed tomography examination (CT or CAT scan)

How is clubfoot treatment administered?

The objective of clubfoot treatment is to restore the foot’s position so that the bones, tendons, and muscles can develop normally. Ideally, treatment should begin within one month of a child’s birth, when their feet and ankles are at their earliest developmental stage.

Ponseti method

The Ponseti technique is the most prevalent and efficient treatment for clubfoot. This treatment employs a succession of casts and braces to correct the position of the infant’s foot. The foot is externally rotated till it is turned out between 60 and 70 degrees. Typically, treatment begins between birth and four weeks of age and consists of two phases: treatment and bracing.

Treatment period

Using a series of casts, the doctor will gradually realign your child’s foot during the treatment phase. This step involves stretching and repositioning the foot for two to three months.

• The doctor will stretch and realign your child’s foot before casting the foot, ankle, and leg to maintain the new position.
• After approximately one week, the doctor will remove the cast and realign your child’s foot. The foot will be held in its new position by a new cast.
• This method will be continued each week until your child’s foot is in the correct outer position rather than the wrong inward position. Typically, five to eight readjustments and cast replacements are required to get the foot into the proper position.
• When the foot is in its improved outward position, the Achilles tendon of the majority of youngsters must be lengthened through minor surgery (tenotomy). This is the tendon connecting the calf muscle to the heel. About 95% of infants require this procedure, which is typically performed under local anaesthetic.

Clubfoot bracing is essential to your child’s long-term mobility and lasts for several years. The brace preserves the correct position of your child’s foot. From the conclusion of the treatment phase until three to six months of age, your child will wear the brace for about 22 hours per day.

After this initial period, your child’s doctor will likely provide permission for the brace to be worn at night and during naps, around 15 or 16 hours each day. When your child is ready to learn how to crawl, walk, run, and play, the brace can be removed.

Good to know: You must completely adhere to the bracing regimen until your child reaches the age of four. This is the most effective approach to prevent your child’s foot from twisting again and requiring additional medical treatment despite the inconvenience.

What is the prognosis for newborns born with clubfoot?

The vast majority of infants with clubfoot who receive early therapy and bracing develop typically functioning feet. They can run and play while wearing regular shoes. If only one foot is afflicted, the affected foot will usually be smaller and less mobile than the unaffected foot. Your child may need shoes in two different sizes. The affected leg may be slightly smaller than the other, and the calf may be less muscular.