Clubfoot in Newborns

Clubfoot Can Cause Walking Problems, But Is Effectively Treated

clubfoot
An adult with an untreated clubfoot deformity.. Franck Metois / Getty Images

Clubfoot is a birth abnormality that causes a newborn baby's feet to point down and inward. While clubfoot does not cause pain, it can cause long-term problems if left untreated, affecting the child's ability to walk normally. However, if clubfoot is properly treated, the deformity can often be cured in early childhood.

Causes of a Clubfoot

The cause of clubfoot is not well understood. While it can be associated with other congenital malformations (such as spina bifida and arthrogryposis), it may also occur independently.

The cause of clubfoot is not due something the mother did during pregnancy.  The deformity occurs in 1-2 of every 1000 births.

When a child is born with clubfoot, the tendons on the inside and the back of the foot are too short. The foot is pulled such that the toes point down and in, and it is held in this position by the shortened tendons.  Clubfoot can either be described as supple (flexible) or rigid.  The rigid deformities are more commonly associated with other congenital malformations, and can be more difficult to treat.

Treatment of Clubfoot

The treatment for clubfoot typically begins soon after the child is born.  Some orthopedic surgeons prefer immediate treatment when the child is still in the hospital.  The advantage is that often parents are worried that any delay is potentially harmful, and the immediate treatment can put people at ease that something is being done.  Other orthopedists prefer to initiate treatment a few weeks after the child is born.

  The advantage is that this gives parents a chance to bond with their newborn without casts in the way.  The truth is, that treatment is not an emergency.  While it should begin in the first weeks of life, the precise timing of treatment should be based on the preference of the parents and the treating orthopedic surgeon.

Usual treatment of a clubfoot consists of the pediatric orthopedic surgeon manipulating the foot and casting in the corrected position.  Over the span of several months, the manipulation is gradually increased to restore the normal position of the foot.  This manipulation technique is called "The Ponseti Method," named after the doctor who has popularized this treatment.

The position and timing of the casts is deliberate, and intended to stretch and rotate the foot into a proper position. Approximately once a week, the casts are replaced in a process called serial casting. The casts slowly correct the position of the clubfoot.

In about one half of cases, this manipulation is sufficient to correct the clubfoot deformity. In some cases, a surgical procedure may be necessary. During surgery, the surgeon will release, or loosen, the tight Achilles tendon to allow the foot to assume its normal position. Once the casts are removed, the child will usually wear nighttime braces until about age two.

Next Steps in Treatment

In some cases, additional surgery is needed to correct the position of the clubfoot. Most often this is needed in cases where the child has other developmental problems (such as arthrogryposis) or if the child begins treatment more than a few months after birth.

If the clubfoot deformity is not corrected, the child will develop an abnormal gait and may have serious skin problems. Because the child will be walking on the outside of the foot, a part of the foot not designed to walk upon, the skin can break down and the child may develop serious infections. Furthermore, the abnormal gait may lead to joint wear and chronic arthritic symptoms.

Sources:

Noonan KJ and Richards BS "Nonsurgical Management of Idiopathic Clubfoot" J. Am. Acad. Ortho. Surg., November/December 2003; 11: 392 - 402.

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