Club Foot Deformity - A Brief Discussion

Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which the foot is twisted out of shape or position.
Also known as talipes equinovarus.
In patients with a club foot any of the following characteristics may be present, and each may vary from mild to severe:

• The foot (especially the heel) is usually smaller than normal.
• The foot may point downward.
• The front of the foot may be rotated toward the other foot.
• The foot may turn in, and in extreme cases, the bottom of the foot can point up.

Clubfoot can happen in one foot or in both feet. In almost half of affected infants, both feet are involved.
A club foot may occur as an isolated feature or, with multiple malformations else where but is usually an isolated problem for an otherwise healthy newborn.

Etiology: The cause of clubfoot is unknown (idiopathic), but it may be a combination of genetics and environment. Certain risk factors like family history, smoking in mother during pregnancy and decreased amniotic fluid may contribute to having club foot in the baby.

Clinical Features: Clubfoot typically doesn't cause any problems until the child starts to stand and walk. Although clubfoot is painless in a baby, treatment should begin immediately. Clubfoot can cause significant problems as the child grows. But with early treatment most children born with clubfoot are able to lead a normal life.

Complications: Untreated club foot can cause serious complications like:

1. Arthritis.
2. Poor self-image. The unusual appearance of the foot may make the child's body image a concern during the teen years.
3.Inability to walk normally. The twist of the ankle may not allow the child to walk on the sole of the foot. To compensate, he or she may walk on the ball of the foot, the outside of the foot or even the top of the foot in severe cases.
4. Problems stemming from walking adjustments. Walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the foot, and result in an awkward gait.

Diagnosis: is mostly clinical and X rays are sometimes needed to determine the severity of club foot. 

Treatment: When treatment for clubfoot starts soon after birth, the foot grows to be stable and positioned to bear weight for standing and moving comfortably.

Newborn baby's bones, joints and tendons are very flexible so the treatment for clubfoot usually begins in the first week or two after birth to get the best results. 

Treatment options include:

• Stretching and casting (Ponseti method)
• Surgery

Nonsurgical treatments such as casting or splinting are usually tried first. The foot (or feet) is moved (manipulated) into the most normal position possible and held (immobilized) in that position until the next treatment. This manipulation and immobilization procedure is repeated every 1 to 2 weeks for 2 to 4 months, moving the foot a little closer toward a normal position each time. Some children have enough improvement that the only further treatment is to keep the foot in the corrected position by splinting it as it grows.

If the clubfoot deformity is severe or doesn't respond to nonsurgical treatments, more invasive surgery may be needed. An orthopedic surgeon can lengthen tendons to help ease the foot into a better position. After surgery, the child will be in a cast for up to two months, and then need to wear a brace for a year or so to prevent the clubfoot from coming back.

Even with treatment, clubfoot may not be totally correctable. But in most cases babies who are treated early grow up to wear ordinary shoes and lead normal, active lives.