Pediatric Orthopaedics Program | Club Feet | Developmental Dysplasia of the Hip | Flatfeet/Vertical Talus/Tarsal Coalition | In-toeing/Out-toeing | Legg-Calve-Perthes Disease | Scoliosis | Slipped Capital Femoral Epiphysis
A clubfoot is a foot that is deformed at birth, pointing downward and inward as well as rotated.
There are four different types of clubfeet:
The remainder of this discussion will focus on congenital clubfeet.
One child out of every 1000 births (0.1%) will have a clubfoot, half of those will have both feet affected. There is an increased incidence in siblings or parents (2% compared to 0.1% chance). It is more common in boys than in girls. The cause of a congenital clubfoot remains unknown; however, popular theories include abnormalities of nerves and muscles and/or the blood supply to the foot. It is usually not due to anything you did or did not do during pregnancy.
Clubfoot is usually diagnosed at birth, and sometimes in utero before birth. In the infant, clubfoot itself is not painful. The heel of the foot turns inward, the foot and toes point down and curve inward. There may be creases above the heel and in the middle bottom portion of the foot. The bones are abnormally shaped and the tendons, muscles, and ligaments are tight. The foot and calf are usually smaller than normal, and the muscles may be weaker and the nerves may be abnormal. Often the blood supply is abnormal as well. Not all clubfeet are the same. Some are flexible while others are stiff. Some deformities are mild yet others are severe. Due to these differences, treatments and outcomes may vary. If untreated, the deformity does not improve on it's own. Rather, the deformity worsens, and if left uncorrected, will become unsightly and crippling, leading to children walking on the top rather than the bottom of their foot. This eventually creates skin breakdown, ulceration, and infection, and can ultimately lead to an amputation in the most severe untreated cases.
Treatment begins as soon as possible after birth. This usually involves manipulation of the foot into the best possible position and holding it with a long leg casting. However, different physicians may use other treatments such as physical therapy, splints, taping, and short leg casts. Typically the manipulation and casting are performed once a week (sometimes biweekly) for 6 to 8 weeks until maximum correction is obtained. The entire casting process may take as long as 3 months. The deformity which is most difficult to correct is the foot pointing down (equinus) and sometimes requires a small outpatient or in office procedure to percutaneously release the heel cord (Achilles tendon). The final cast is usually worn for 3 weeks after either the deformity is corrected or the heel cord is released.
The majority of feet can be corrected in this manner. Sometime between ages 3 and 6 months a decision is made regarding whether the casting has been successful and whether surgery will be necessary. If casting is successful, the foot will then be held in either a plastic brace, or a corrective shoe and bar to maintain the correction until the child begins to walk. If the foot is not completely corrected or if the deformity recurs following correction, surgery is usually suggested. Surgery is usually done between 6 and 9 months of age so that the foot is corrected by the time the child is ready to stand and walk.
The surgery to correct the foot usually consists of releasing abnormal joints and tight ligaments, as well as lengthening and/or releasing tight tendons in order to move the bones into a more normal position. The bones may be held in position with pins. The amount of surgery to correct the foot varies upon the severity of the clubfoot. After surgery the foot is held in a cast for 6 to 12 weeks followed by use of a plastic brace to hold the foot in a corrected position and limit the possibility of recurrence. Depending upon surgeon preference the brace may be used for up to one year after surgery.
There is a 20-25% chance of recurrence of the deformity after successful correction (by either casting or surgery). This may require further surgery and/or casting. The surgery consists of tendon transfers, joint release, cutting and moving bones, and/or fusing bones together. Close follow-up throughout the growing years of a child is mandatory. No matter what the treatment, the goal is to create a foot with the sole on the ground, which is flexible and pain free. Most children with corrected clubfeet will be able to participate in most aspects of childhood with little or no difficulty and do well into their adult years. Even after growth is complete, the patient with a clubfoot will need to be followed into their adult years to ensure a well functioning foot.
For more information about club feet and available treatment options, please visit the Department of Orthopaedics Foot and Ankle Program.