Clubfoot is a congenital deformity found in infants that results in the heel and toes twisting inwards. In some cases, the condition is so severe that the sole of the foot can be facing sideways or even upwards. Statistically one child out of every 1,000 will be born a clubfoot, and half of those will have both feet affected. Clubfoot is often diagnosed during inter-utera diagnostic ultrasound scanning or just after birth.
Parents often come into clinic before the baby is born to discuss their treatment options and plan for correcting the clubfoot once baby is born. Our podiatrists are acutely aware that bonding with the baby in the first couple of weeks is vital and therefore it is emphasises that commencement of treatment can be slightly delayed, but it is important to note that earlier treatment produces best results.
In an infant, clubfoot itself is not painful. However, if untreated, it does not improve on its own and will worsen. Eventually patients will suffer skin breakdown, ulceration and infection. In the most severe untreated cases, it can ultimately lead to an amputation.
While there is no definitive cause for clubfoot, there are a number of factors that contribute to a child being born with clubfoot.
- Male babies are more likely to be born with clubfoot
- Babies are more likely to have it if a family member has it
- Smoking may increase the risk of clubfoot
- Other birth defects
Clubfoot is classified into two main sections; isolated (idiopathic) and nonisolated. Isolated clubfoot is when the child develops clubfoot without any other medical conditions. However, in nonisolated cases, clubfoot is due to a combination of other musculoskeletal conditions or neuromuscular disorders such as spina bifida. This type of clubfoot requires an extended period of treatment and may require surgical consideration.
- The top of the foot is twisted downwards and inwards. May be twisted to the point where the foot looks upside down
- The affected limbs may shorter than normal as the muscles, specifically the calves, are underdeveloped
- If only one foot is affected, it could be up to 1 cm shorter than the other
- In adulthood patients can develop further deformities and painful calluses
Podiatry Treatments for clubfoot (baby – child – adult)
Treatments for clubfoot aim for a fully functioning, painless foot with little to no deformity present (club foot naturally will result in a more rigid foot type). Conservative or minimally invasive treatments have taken over traditional full surgical corrective approaches over the last decade and this is what our podiatrists specialize with.
- Examination, evaluation and advice
- Serial (weekly) rigid casting
- Soft casting and splints
- Long term orthotics and braces
- Focal and radial ESWT
- Surgical referral if required
The Ponseti method is a common treatment approach that utilises gentle stretching and encasing the leg in a cast in order to gradually correct clubfoot. In the first stage, the foot is stretched and manipulated to a better alignment before being casted from the toes up to the thigh. This holds the lower limb in a corrected position. Each week this process is repeated with further stretching taking place until a fully corrected position can be held. This usually takes around 6 – 8 weeks.
To ensure that clubfoot correction is maintained following initial casting and foot moulding treatments, long term treatments such as bracing, prescription insoles and radial shockwave therapy may be recommended by your podiatrist.
In the majority of children who seek non-surgical treatment such as stretching, casting and braces, no long-lasting effects will persist. Visiting a podiatrist can help you find out more about what your child needs.