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The medical term for clubfoot is talipes equinovarus and this describes the position of the foot. The feet are pointed down (equinus) and inward (varus). The feet are usually stiff and difficult to get out of this position. This is different from other children's feet which may be curved but are very flexible. In some instances, the toes of the foot are touching the shin portion of the lower leg. There are varying degrees of severity in the appearance of a clubfoot.
Clubfoot also affects the lower leg in that the muscles in that area, such as the calf, will appear smaller and less developed. This is a normal part of the appearance of a clubfoot.
What causes Clubfoot?
The concern many parents have when their child is born is, "Did I do something wrong to cause this?" The answer is no. Clubfoot is not caused by anything you ate or drank during pregnancy.
Most children have what is called idiopathic clubfeet, meaning we are unsure the exact cause. One theory as to what causes clubfoot is the arrest of fetal development theory, which suggests that all babies’ feet are held in a clubfoot position during the earlier stages of pregnancy. In some children, the feet simply do not turn out to the normal position. Other experts are of the opinion that either nerve or muscle problems in the lower leg cause the foot, or feet, to be turned in.
Clubfeet are sometimes associated with other conditions such as spina bifida or arthrogryposis. Patients with arthrogryposis may have a more severe form of clubfoot.
Is this a problem?
Children who are born with clubfoot need treatment for it. The feet will not correct on their own and in this instance, yes, it is a problem. The child can also have recurrrence of the deformity as they grow, needing additional treatment over time.
What are the treatment options?
It is important to realize there are many variations of clubfoot. Some children can have a very mild case, while others can have a very severe case with very stiff feet. Although it is the same condition, the severity will be different in different children and this is the reason some children will only need casting, and others need surgery.
Our goal with treatment of clubfoot is to have a foot which is flat, fits in shoes well, and does not hurt. Just a hundred years ago we were unable to treat clubfeet very well and children with clubfeet grew up to walk on the outside of their feet as adults. We are much better at treating clubfeet now and most children fit in normal shoes. Most children's treated clubfoot will not look exactly like the other foot. The foot will still turn in a little bit, or some children may walk on the outside of the foot just slightly. However, we expect that most children will be able to wear normal shoes without pain. It is important to realize that whatever causes clubfoot actually involves the whole lower leg. Most children with clubfeet have skinny calves. This is not caused by casting.
Casting: Initially your child will be placed in casts for his clubfeet. The casts will be changed every week for approximately 4 to 6 weeks. Most children then need a small office procedure to lengthen the heel cord - Achilles tendon lengthening (TAL). Your child will then be placed in a cast for 3 more weeks. The clubfoot is fully corrected at this point. The clubfoot appearance will come back if the child does not wear the special shoes and bar.
Bracing: Your child will be given a prescription for Dennis-Brown Bar (as pictured), a type of brace with shoes and bar. Your child should wear this 23 hours per day for the first three months and then at night and with naps until he/she is 2 years old.
Surgery: If the casting and bracing doesn't fully correct the child's clubfeet then we recommend surgery usually between 2-3 years of age. We wait this long so that your child is a little bit older and can handle the anesthesia easier. Also, the foot will be bigger and easier to operate on.
Unfortunately, some clubfeet come back. The risk of recurrence in all reported series is between one in four and one in five. We tell parents that each clubfoot will need an average of 1.6 surgeries. That means that many feet only need one surgery, however, some children's feet
will need 2 to 3 surgeries. It is very difficult to tell which children will recur. Sometimes recurrence occurs 2 to 3 years after the initial surgery.
What will my child be like when they grow up?
Luckily children with clubfeet are very healthy children in every other respect. They are normal mentally. Your child will not have any restrictions as to what they can and cannot do. Most children are pain-free and able to really do most activities with other young children.
The calf of the children will tend to be smaller as they grow older. This is not from casting but is from the clubfoot itself. The condition of clubfoot is not isolated to the foot but actually involves the whole leg. Sometimes children will even need to wear different shoe sizes because the clubfoot will be smaller than the other one.
Rarely, children will have to wear braces. Very rarely a child will have painful feet and will need surgery to fuse the bones in the foot to stop the pain. This is called a triple arthrodesis and is unusual for children to need this.
Will they be able to play sports?
The muscles in the legs of children with clubfeet are not developed as well as the other muscles. Sometimes children with clubfeet will tire easily. However, there are children with clubfeet who have played collegiate football. This is the exception rather than the rule but your child will not be restricted from doing any activities as long as they are not painful. Most children with clubfeet are not star athletes, but this is true for children born without clubfeet.
Clubfoot is a scary thing when your child is born with this initially. However, we will do everything we can to help you understand the treatment and outcome of children with clubfeet. Please don't hesitate to ask any questions.
What is the chance that the other children will get it?
Clubfeet occurs in one in a thousand live births. It is more common in boys, although girls can also be affected. If a direct relative has clubfeet then the chances go up to one in thirty-five. If you have a male child with clubfeet the chance of another boy having clubfeet is one in seventeen, and with girls is one in thirty.