Congenital clubfoot is the term that describes an abnormality in which a shortened Achilles tendon causes the foot to be turned inward. In congenital clubfoot, the foot is twisted out of shape or position, and the tendons that connect the muscles to the bones of the foot are shorter than in a healthy foot. Half of all babies born with clubfoot have it in both feet.
Though discovering their baby has been born with a congenital clubfoot can be alarming to new parents, this diagnosis is usually an isolated problem in an otherwise healthy newborn, and it can be corrected.
What does congenital clubfoot look like?
Most of the time, as soon as a baby is born, doctors will be able to see that it has been born with congenital clubfoot. Here are some examples of what a clubfoot may look like:
- The top of the foot is twisted downward, increasing the arch and turning the heel of the foot inward.
- The foot may be so severely turned that it appears upside down
- The affected leg may be shorter
- The foot may be shorter
- The calf muscles of the affected leg may be underdeveloped
What causes congenital clubfoot?
Congenital clubfoot, also known as talipes equinovarus (TEV) or congenital talipes equinovarus (CTEV), often appears with no apparent cause. Most cases of clubfoot are idiopathic, meaning that the cause of the condition is unknown.
Certain risk factors increase the incidence of congenital clubfoot in newborns, including:
- Skeletal abnormalities such as spina bifida
- Advanced maternal age
- Maternal smoking while pregnant
- Diabetes in the mother
- Low level of amniotic fluid in the womb
- Being male – Boys are twice as likely to be born with congenital clubfoot as girls
- Having a parent that was born with congenital clubfoot
Clubfoot is divided into three different types based on the cause of the condition: idiopathic, neurogenic, and syndromic.
Idiopathic clubfoot is the most common type of clubfoot. This refers to clubfoot with no apparent cause. One out of every 1,000 babies is born with idiopathic clubfoot.
Neurogenic clubfoot is caused by an underlying neurological condition such as spina bifida. Neurogenic clubfoot can also develop later in life in patients with cerebral palsy or spinal cord compression.
Syndromic clubfoot occurs along with other conditions that are related to the same underlying syndrome.
Syndromes associated with clubfoot
Syndromes associated with clubfoot include arthrogryposis, constriction band syndrome, tibial hemimelia, and diastrophic dwarfism.
Arthrogryposis – Also known as AMC, arthrogryposis is a term used to describe a number of different conditions characterized by stiffness in multiple joints. Types of arthrogryposis include Gordon syndrome and Freeman Sheldon syndrome.
Constriction band syndrome – Constriction band syndrome is a rare condition in which a fetus becomes entangled in the amniotic membrane, leading to deformities such as clubfoot.
Tibial hemimelia – Tibial hemimelia is a condition in which a baby is born with a tibia that is shorter than normal. Sometimes with this condition, the tibia is missing altogether.
Diastrophic dwarfism – Diastrophic dwarfism is a skeletal condition that affects cartilage and bone development and results in short stature.
Clubfoot generally causes no distress or pain in infants and produces no adverse effects until the child is learning to walk. However, doctors usually recommend that congenital clubfoot be treated as soon as possible after birth so that the baby is fully prepared to learn to walk when they reach the appropriate age. Clubfoot does not improve with growth. Treatment is necessary to restore the function of the affected feet and legs.
Clubfoot treatment happens in two phases – Ponseti casting and bracing
Ponseti casting involves a series of casts that slowly stretch and manipulate the clubfoot into proper position. The first cast is usually applied in the first two weeks after a baby’s birth. Every seven to 10 days, the cast is removed, the foot is further stretched and manipulated, and then a new cast is applied.
At the fourth or fifth casting appointment, an in-office procedure is done to lengthen the Achilles tendon. The baby is then placed into the final casting of treatment, which remains on for two to three weeks.
Once the baby’s final cast is removed, he or she will be fitted with a supramalleolar orthosis brace with a bar. This brace is necessary to maintain the correction that was accomplished with the Ponseti casting technique. This brace will be worn for 23 hours every day for approximately two months. After two months, the brace will be worn for 12 hours a day until the child reaches kindergarten age.
For children who are not well suited or do not respond well to the Ponseti casting and bracing method of clubfoot treatment, clubfoot surgery may be recommended to align the foot into a more normal position. Clubfoot surgery generally includes releasing and lengthening the short tendons that are causing the deformity.
Once the surgeon lengthens and releases the tendons in the clubfoot, the corrections are held in place by pins. These pins will be removed in the office between four and six weeks after surgery. Once the pins are removed, the patient’s foot will be placed in a cast for the following six to 12 weeks. After the cast is removed, some patients will need to continue to wear a brace for a certain period of time.
Prognosis for children with congenital clubfoot
After clubfoot treatment is fully completed, the affected foot should look, act and function like a normal foot. Children born with congenital clubfoot go on to participate in sports, dance, cheerleading, and other activities after treatment. No special footwear is required after the completion of clubfoot treatment.
Need a second opinion about your child’s clubfoot diagnosis?
For more information on congenital clubfoot, or to have your child evaluated for congenital clubfoot, please click on Connect with a Doctor to reach one of our board-certified orthopedic specialists. BICMD’s nationwide network of orthopedic surgeons can help you decide which treatment is best for your child. Our physicians are top orthopedic doctors hand-picked from reputable organizations nationwide and are extremely skilled with congenital clubfoot cases.