Clubfoot is an abnormal inward curving of the foot. One of the most common nonmajor birth defects, clubfoot affects a child’s foot and ankle, twisting the heel and toes inward. The clubfoot, calf, and leg are smaller and shorter than normal.
Approximately 1 in every 1,000 newborns has clubfoot. Of those, 1 in 3 have both feet affected and 2 out of 3 are boys. Clubfoot is twice as likely if the baby’s parents or their other children also have it. Less severe infant foot problems also are common and sometimes mislabeled as clubfoot.
Clubfoot is not painful and the deformity is correctable.
Treatment begins right away to correct the alignment of the foot. The goal is to make your newborn’s clubfoot (or feet) functional, painless, and stable by the time he or she is ready to walk.
Your foot and ankle orthopaedic surgeon will start treatment by gently stretching your child’s clubfoot toward the correct position. They put on a cast to hold it in place. One week later, they take off the cast and stretch your baby’s foot a little more, always working the foot toward the correct position. They then apply a new cast. One week later you will return to the surgeon and they will do the same thing again. This process, called serial casting, slowly moves the bones in the clubfoot into proper alignment. Your surgeon uses X-rays to check the progress. Casting generally repeats for 6-12 weeks and may take up to four months. (Note: Anytime your baby wears a cast, watch for changes in skin color or temperature that may indicate problems with circulation.)
In about half of cases, the child’s clubfoot straightens with casting. If it does, he or she will be fitted with special shoes or braces to keep the foot straight. These holding devices usually are needed until your child has been walking for a year or more. Muscles often try to return to the clubfoot position. This is common when your child is 2-3 years old but may continue up to age 7.
Sometimes stretching, casting, and bracing are not enough to correct your baby’s clubfoot and surgery is needed to adjust the tendons, ligaments, and joints in the foot and ankle. This usually is done when your child is 6-12 months old. Surgery corrects all of your baby’s clubfoot deformities at the same time. After surgery, another cast holds the clubfoot together while it heals. Since it’s still possible for the muscles in your child’s foot to try to return to the clubfoot position, special shoes or braces likely will be used for a year or more after surgery.
With treatment, your child should have a nearly normal foot. He or she can usually run and play without pain and can wear normal shoes. The corrected clubfoot will not be perfect, however. You should expect it to stay one to one-and-a-half sizes smaller and somewhat less mobile than the normal foot. The calf muscles in your child’s clubfoot leg also will be smaller.
Distraction arthroplasty is a distraction (stretching out) of the ankle joint. This technique is used to unload the ankle joint and allow healing of the damaged joint.
The heel bone can be realigned to achieve a different orientation, which can correct many different deformities and foot/ankle problems.