Clubfoot

Diagnosis

Many times, a healthcare professional diagnoses clubfoot soon after birth just from looking at the shape and position of the newborn's foot. Sometimes X-rays are taken to fully understand how severe the clubfoot is. But usually X-rays are not needed.

Often clubfoot can be seen before birth during a routine ultrasound exam in week 20 of pregnancy. While the condition can't be treated before birth, knowing about the condition may give you time to learn more about clubfoot. You'll have time to talk with health experts, such as a pediatric orthopedic surgeon, to plan treatment. If needed, a medical genetics counselor can talk with you about genetic test results and your risk of having a baby with clubfoot in future pregnancies.

Treatment

Because a newborn's bones, joints and tendons are very flexible, treatment for clubfoot usually begins in the first week or two after birth. The goals of treatment are to move the child's foot into a corrected position with the bottom of the foot facing the ground. Treatment with casting allows for the best movement of the foot and best long-term results. Treatment is most effective if done in the first few months of age.

Treatment options include:

• Stretching and casting, called the Ponseti method.
• Stretching, splinting and taping, called the French method.
• Surgery.

Casting: Ponseti method

Casting is the main treatment for clubfoot. The healthcare professional typically:

• Moves your baby's foot into an improved position and then places it in a cast to hold it there.
• Repositions and recasts your baby's foot once a week for several months.
• Performs a minor procedure to lengthen the heel tendon, called the Achilles tendon, toward the end of this process.

After the shape of your baby's foot is improved, the foot needs to stay in position. To help your child keep the foot in position:

• Put your child in special shoes and braces.
• Make sure your child wears the shoes and braces as long as needed. This is usually all day and all night for 3 to 6 months, and then at night and during naps until your child is 3 to 4 years of age.

For this method to be successful, the braces need to be worn exactly as instructed so that the foot doesn't go back to its original turned position. When the Ponseti casting approach doesn't work, the main reason is because the braces aren't worn as instructed. If your child can't wear the braces or outgrows the braces, talk with your healthcare professional right away.

Even with treatment, clubfoot may not be totally correctable. For some children, the foot may begin to turn in again. If this happens before age 2, it can require more casting to return the foot to the correct position. But most of the time, babies who are treated early grow up to wear regular shoes without braces, participate in sports, and lead full, active lives.

Stretching, splinting and taping: French method

The French method was developed in France and is most often used only in France. It is a type of stretching treatment that is best for mild clubfoot. The foot is stretched into position, then taped and splinted every day. The method involves frequent physical therapy appointments and daily treatments done by parents until the child is 2 to 3 years old. A minor procedure to lengthen the heel tendon, called the Achilles tendon, is usually needed.

Surgery

If a baby's clubfoot doesn't improve with the casting method or if a child doesn't have complete correction later in life, surgery may be needed. Even with a successful result in infancy, surgery is sometimes needed around 3 to 5 years of age if the child's foot is still turning in. During surgery, an orthopedic surgeon repositions tendons to help keep the foot in a better position. This surgery is called a tibialis anterior tendon transfer and has very good results.

Rarely for severe clubfoot or for clubfoot that is part of a syndrome or other underlying medical conditions, more extensive surgery may be needed in infancy. This surgery is called a posterior release or posteromedial release. This surgery loosens the ligaments in the back and side of the ankle and can result in larger correction of the foot. Even though the foot is in a better position, the foot can become stiff and pain in the foot is more likely later in life.

After surgery, the child is in a cast for up to two months. Then the child wears a brace for several years or so to keep clubfoot from coming back.

Preparing for your appointment

If your baby is born with clubfoot, the condition will likely be diagnosed during pregnancy or soon after birth. Your baby's healthcare professional will likely refer you to a specialist in bone and muscle conditions in children called a pediatric orthopedic surgeon.

If you have time before meeting with your child's healthcare professional, make a list of questions to ask. These may include:

• Do you commonly treat newborns with clubfoot?
• Should my child be referred to a specialist?
• What types of treatment are available?
• 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?
• After treatment, will my child be able to walk well?
• Do you have any information that can help me learn more? What websites do you suggest?

Feel free to ask other questions during your appointment.

Also tell your healthcare professional if you:

• Have family members, including extended family, who have clubfoot.
• Had any problems during your pregnancy.

Being ready for your appointment can give you time to talk about what's most important to you.