General Information

Clubfoot is a congential malformation that begins in the first trimester of pregnancy. Infants with clubfoot are born with an abnormally shaped foot – one that is rotated inward and turned on its side toward the other foot. If the baby were to try to stand on the clubfoot, the outside of the foot would rest on the floor. Often the calf, leg and foot on the affected side are smaller and shorter than the other side. Clubfoot occurs in about 1 in 1,000 newborns and about 1/3 of these infants will have clubfeet on both sides. Most babies with clubfoot have no other abnormalities or problems. Clubfoot occurs more often in boys than girls and is twice as likely if the mother, father or a sibling has clubfoot. Clubfoot is not painful and is easily corrected with the proper treatment.

There are two main types of clubfeet, idiopathic and neurologic, which is also known as teratogenic. Idiopathis means that the condition has occurred without a known cause. Some of these cases are due to the position of the feet in the uterus, these clubfeet tend to be very mild in severity. Studies have shown, however, that in the majority of idiopathic clubfeet the tendons, ligaments and muscles of that foot are slightly abnormal when compared to normal feet. Neurologic or teratogenic clubfeet occur as a result of nerve, brain, muscle or skeletal problems in children with conditions such as spina bifida, arthrogryposis, or dwarfism.

Treatment

The treatment of clubfeet was invented by Dr. Ignacio Ponsetti over 50 years ago, and is called the Ponsetti casting technique. The treatment should begin as soon as possible after birth, and preferably within the first two weeks of life, because the tissue in the infant’s ligaments, tendons and joints are most elastic at this stage. The goal is to stretch out the abnormal structures in the foot, then put the foot in a long leg cast to hold it in the new position and continue to soften and stretch the ligaments. By doing this, the bones in the foot are gradually put into the correct position. This is done every week for six weeks. One week after the sixth cast is put on, the child goes to the operating room to have a small procedure where the Achilles tendon (the large tendon in the back of the heel) is cut. This allows the foot to come down into the correct position and the final cast is applied and kept on for three weeks. During this time, the tendon is healing and growing into a new, longer position.

After this cast is removed, the child is given Dennis Browne Braces, which are two baby shoes connected to a bar and held at a certain angle to help position the foot correctly. The child wears this brace all the time for three months. After these three months, the braces are worn only while the child is sleeping until they are two years old. Better results and less recurrence of the clubfoot are seen the longer the child wears the brace.

Only 25% of children treated with the Ponsetti casting technique will require surgery in the future. As the child grows, sometimes the tendons, ligaments and muscles in the clubfoot want to go back into the abnormal position. The corrective surgery can range from a small tendon transfer to a larger procedure involving the bones in the foot. If the clubfoot does not respond to casting, a larger surgery is required when the baby is 6 months old. This is very rare.

Clubfeet that are due to neurologic causes tend to be much more rigid than idiopathic clubfeet. The Ponsetti technique may be attempted, but results are usually not as good as with idiopathic clubfeet. Usually these children will require more extensive surgery.

FAQ’s:

Will my child always have trouble with the foot or feet that was a clubfoot at birth?
Most children with clubfeet treated via the Ponsetti technique have few problems. The goal of treatment is a flexible, pain free foot.

Will the clubfoot look the same as the other side once treatment is finished?
Because the endon/muscle/ligaments of a clubfoot are abnormal, the foot and calf of the clubfoot side may be smaller than the other side. This usually does not cause significant problems. The smaller foot or calf should not limit the child in sports or activities. The smaller calf will remain smaller, and there is very little that can be done to make it equal to the other side.

Will the clubfoot come back after treatment?
Usually not, but as the child grows, some parts of the clubfoot may want to return. It is because of this that the child is followed closely by an orthopedic surgeon for a long time.

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