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ClubfootBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/clubfoot/DS00814
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Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your baby's foot is twisted out of shape or position. In clubfoot, the tissues connecting the muscles to the bone (tendons) are shorter than usual. The term "clubfoot" refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. Clubfoot is a fairly common birth defect and is usually an isolated problem for an otherwise healthy newborn.
Clubfoot can be mild or severe. About half of children with clubfoot have it in both feet. If your child has clubfoot, it will make it hard for him or her to walk normally, so doctors generally recommend treating it soon after birth.
Doctors are usually able to treat clubfoot successfully, though sometimes children need follow-up surgery later on.
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If your child has clubfoot, his or her foot may have the following appearance:
- The top of the foot is usually twisted downward and inward, increasing the arch and turning the heel inward.
- The foot may be turned so severely that it actually looks as if it's upside down.
- The calf muscles in the affected leg are usually underdeveloped.
- The affected foot may be up to 1/2 inch (about 1 centimeter) shorter than the other foot.
Despite its look, however, clubfoot itself doesn't cause any discomfort or pain.
When to see a doctor
More than likely your doctor will notice clubfoot soon after your child is born, based on appearance. You'll likely be advised on the most appropriate treatment.
The cause of clubfoot is unknown (idiopathic). But scientists do know that clubfoot is not caused by the position of the baby in the womb (fetus). In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth (congenital), such as spina bifida, a serious birth defect that occurs when the tissue surrounding the developing spinal cord of a fetus doesn't close properly.
The environment plays a role in causing clubfoot. Studies have strongly linked clubfoot to cigarette smoking during pregnancy, especially when there already is a family history of clubfoot.
Risk factors include:
- Sex. Clubfoot is more common in males.
- Family history. If either one of the parents or their other children have had clubfoot, the baby is more likely to have it as well. It's also more common if the baby has another birth defect.
- Smoking during pregnancy. If a woman with a family history of clubfoot smokes during pregnancy, her baby's risk of the condition may be 20 times greater than average.
- Not enough amniotic fluid during pregnancy. Too little of the fluid that surrounds the baby in the womb may increase the risk of clubfoot.
- Getting an infection or using illicit drugs during pregnancy. These can increase the risk of clubfoot as well.
Clubfoot typically doesn't cause any problems until your child starts to stand and walk. If the clubfoot is treated, your child will most likely walk fairly normally. He or she may have some difficulty with:
- Mobility. Your child's mobility may be slightly limited.
- Shoe size. The affected foot may be up to 1 1/2 shoe sizes smaller than the unaffected foot.
However, if not treated, clubfoot causes more-serious problems. These can include:
- Arthritis. Your child is likely to develop arthritis.
- Poor self-image. The unusual appearance of the foot may make your child's body image a concern during the teen years.
- Inability to walk normally. The twist of the ankle may not allow your child to walk on the soles of the feet. To compensate, he or she may walk on the balls of the feet, the outside of the feet or even the top of the feet in severe cases.
- Muscle development problems. These walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the feet, and result in an awkward gait.
Preparing for your appointment
If your baby is born with clubfoot, he or she will likely be diagnosed soon after birth. In some cases, your baby's doctor may refer you to a doctor who specializes in bone and muscle (musculoskeletal) problems (pediatric orthopedist).
If you have time before meeting with your child's doctor, it's a good idea to make a list of questions. Your time with the doctor may be limited, so it helps to be prepared. Here are some questions to consider asking:
- What types of corrective treatment are available for my child's condition?
- Will my child need surgery?
- What kind of follow-up care will my child need?
- Should I get a second opinion before beginning my child's treatment? Will my insurance cover it?
- Can you tell how complete a recovery my child will have and whether he or she will have a normal gait?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
In addition, tell your doctor:
- If you have family members — including extended family — who've had clubfoot
- If you had any medical issues or problems during your pregnancy
It's also a good idea to ask your doctor if he or she commonly treats newborns with clubfoot, or ask if you should get a referral to another doctor.
Tests and diagnosis
Most commonly, a doctor recognizes clubfoot soon after birth just from looking at the shape and positioning of the newborn's feet. Occasionally, the doctor may request X-rays to fully understand how severe the clubfoot is, but usually X-rays are not necessary.
It's possible to clearly see some cases of clubfoot before birth during a baby's ultrasound examination. If clubfoot affects both feet, it's more likely to be seen in an ultrasound. While nothing can be done before birth to solve the problem, knowing about the condition may give you time to learn more about clubfoot and get in touch with appropriate health experts, such as a genetic counselor or an orthopedic surgeon.
Treatments and drugs
Because your newborn's bones and joints are extremely flexible, treatment for clubfoot usually begins in the first week or two after birth. The goal of treatment is to improve the way your child's foot looks and works before he or she learns to walk, in hopes of preventing long-term disabilities. Treatment options include:
Stretching and casting (Ponseti method)
This is the most common treatment for clubfoot. The doctor will do the following:
- Move the baby's foot into a correct position and then place it in a cast to hold it in that position
- Reposition and recast the baby's foot once or twice a week for several months
- Perform a minor surgical procedure to lengthen the Achilles tendon (percutaneous Achilles tenotomy) toward the end of this process
After the shape of the foot is realigned, parents will need to maintain it by doing one or more of the following:
- Doing stretching exercises with your baby
- Putting your child in special shoes and braces
- Making sure your child wears the shoes and braces as long as needed — usually full time for three months, and then at night for up to three years
For this method to be successful, you'll need to apply the braces according to your doctor's directions so that the foot doesn't return to its original position. The main reason that this procedure sometimes doesn't work is because the braces are not used constantly.
Stretching and taping (French method)
This approach is also called the functional method or the physiotherapy method. Working with a physical therapist, parents:
- Move the foot daily and hold it in position with adhesive tape
- Use a machine to continuously move the baby's foot while he or she sleeps
- After two months, cut treatment back to three times a week until the baby is 6 months old
- Once the shape is corrected, continue to perform daily exercises and use night splints until the baby is of walking age
This method requires a much greater time commitment than does the Ponseti method. Some caregivers combine the French method and the Ponseti method.
In some cases, when clubfoot is severe or doesn't respond to nonsurgical treatments, babies may need more invasive surgery. An orthopedic surgeon can lengthen tendons to help ease the foot into a better position. After surgery, your 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.
Because doctors don't know what causes clubfoot, you can't completely prevent it. However, if you're pregnant, you can do things to limit your baby's risk of birth defects, such as clubfoot, including:
- not smoking or spending time in smoky environments
- not drinking alcohol
- avoiding drugs not approved by your doctor
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- AskMayoExpert. Is further surgical intervention needed for congenital clubfoot? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- AskMayoExpert. Are other medical conditions associated with congenital clubfoot? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- AskMayoExpert. Why should a patient be referred to a pediatric orthopedic surgeon for the treatment of congenital clubfoot? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- AskMayoExpert. What is the usual treatment for congenital clubfoot? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- AskMayoExpert. Clubfoot: Key facts. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
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