Clubfoot

What is clubfoot?

Clubfoot is a deformity (birth defect) in which your baby’s foot or feet turn inward. When you look at their foot, the bottom often faces sideways or even up. Another name for club foot is talipes equinovarus. Clubfoot is a common congenital (present at birth) condition. About 1 out of every 1,000 newborns will have clubfoot.

Clubfoot happens because of an issue with your child’s tendons, the tissues that connect muscle to bone. The tendons in your baby’s leg and foot are shorter and tighter than they should be. That causes the foot to twist. About half of babies with clubfoot have an issue with both feet.

Extensive surgery used to be the main treatment to correct clubfoot. But today, healthcare providers typically use a combination of nonsurgical methods and a minor procedure.

Types of clubfoot

There are two types of clubfoot:

• Isolated or idiopathic clubfoot: This is the most common type. If your child has clubfoot with no other medical issues, it’s called isolated clubfoot. Idiopathic means that the cause of clubfoot isn’t known.
• Nonisolated clubfoot: Nonisolated clubfoot happens along with other health conditions. These conditions include arthrogryposis (a joint problem) and spina bifida (a neural tube disorder). Neural tube defects are issues with your baby’s brain, spine and spinal cord.

What are the symptoms of clubfoot?

The most common sign of clubfoot is one or both feet turning inward. Your baby’s foot faces the opposite leg.

You may also notice that their foot has a:

• Kidney shape.
• Deep crease on the inside.
• Higher arch than normal (called cavus foot deformity).

Other clubfoot symptoms you may notice include:

• A smaller calf muscle in the affected leg.
• Shorter foot.
• Ankle stiffness.
• Lack of full range of motion in their foot.

What causes clubfoot?

Researchers don’t know the exact cause of clubfoot. It’s most likely a combination of genetics and environment:

• Genetics: Genes tell your child’s body how to look, grow and function. A problem with one or more genes (which are passed down from parents to children) could result in clubfoot.
• Environment: Drug use and smoking during pregnancy may raise the risk of having a baby with a birth defect like clubfoot.

Who is at risk for congenital clubfoot?

Babies assigned male at birth (AMAB) are up to twice as likely to develop clubfoot as babies assigned female at birth (AFAB). A family history of clubfoot also puts your baby at a higher risk.

Babies are also at a higher risk if they have:

• Another birth defect, like spina bifida or cerebral palsy.
• A genetic condition, such as Trisomy 18 (Edward syndrome).

A person may be at higher risk for having a baby with clubfoot if they:

• Had oligohydramnios during pregnancy. This is a problem of not having enough amniotic fluid, the fluid that surrounds the fetus.
• Had Zika infection during pregnancy, which can lead to birth defects and other issues.
• Smoked, drank alcohol or used recreational drugs during pregnancy.

How does clubfoot affect my baby?

Clubfoot isn’t painful for your baby. Many babies won’t even notice it during the first few months of life. But clubfoot will get in the way of standing and walking. It won’t go away on its own. Babies with clubfoot need treatment to correct the problem before they reach walking age.

Untreated clubfoot can lead to:

• Walking problems. Babies with clubfoot often walk in unusual ways. Typically, people walk on the bottoms and soles of their feet. A baby with clubfoot may walk on the sides and tops of their feet.
• Foot infections.
• Foot problems, including calluses. A callus is a thick layer of skin that often develops on the sole of the foot.
• Arthritis, a joint condition that causes pain, stiffness and swelling.

When and how is clubfoot diagnosed?

Many times, a healthcare provider notices clubfoot when you’re having an ultrasound during pregnancy. A prenatal ultrasound shows pictures of the developing fetus. If your provider diagnoses clubfoot during pregnancy, you can start planning for the treatment your child will need after birth.

Other times, your provider may diagnose clubfoot after your baby is born. They’ll usually notice it during one of your baby’s first physical exams. In some cases, your provider may recommend an X-ray to confirm the diagnosis.

When should clubfoot treatment start?

Healthcare providers recommend treating clubfoot as soon as possible. Early treatment helps your child avoid problems later. It’s best to begin treatment during your baby’s first two weeks of life.

Who treats clubfoot?

Your baby will likely need a team of healthcare providers to treat clubfoot, including a:

• Pediatric orthopedist: Specializes in bone and joint problems in children.
• Orthopedic surgeon: Specializes in surgery for bones and joints.
• Physical therapist: Helps your child build strength and move their foot.

How is clubfoot treated?

Clubfoot treatment includes several methods. Your care team will discuss the options with you and figure out which works best for your child. Treatments include:

• Ponseti method: Stretches and casts on your child’s leg to correct the curve.
• French method: Stretches and splints on their leg to correct the curve.
• Bracing: Uses special shoes to keep their foot at the proper angle.
• Surgery: May be an option if other methods don’t work.

Ponseti method

The Ponseti method is the most popular treatment method involving serial casting. It lasts about two to three months. Your care team will start this therapy within the first two weeks after birth.

An orthopedic surgeon performs this method. They’ll:

1. Stretch your baby’s foot toward the correct position.
2. Put their foot in a cast, which starts at their toes and goes all the way to their upper thigh.
3. Repeat this process every four to seven days with a new cast. Each time, the surgeon moves their foot a little closer to the correct position.

Before the final cast, the surgeon typically performs an Achilles tenotomy. They:

1. Cut your baby’s heel cord (Achilles tendon) in a quick procedure. This tendon connects their heel to their calf muscles. The cut is small and won’t need stitches.
2. Put on a new cast as their tendon heals, which takes about three weeks.

The goal of this surgery is to allow the tendon to grow to a typical length. When the last cast comes off, the tendon has reached a regular length. As your baby recovers, they may need to:

• Do stretching exercises so their feet stay in the correct position.
• Wear special shoes or a foot brace for a few years.

French method

This method is similar to the Ponseti method, but it uses splinting and taping instead of casting. A splint is a device that supports and protects bones.

A physical therapist performs this treatment. They’ll start the treatment soon after birth. This treatment needs to be done every day rather than once a week. But you don’t need to return to the physical therapist each time. The physical therapist sees your child a few times a week and teaches you how to do the splinting and taping at home.

How to do the French method to fix clubfoot:

1. Stretch your baby’s foot toward the correct position.
2. Hold their foot in place using tape and splints.
3. Repeat this process every day for two months.
4. Repeat the process less frequently until your baby is 3 months old. (The physical therapist will tell you how often to do it.)

Babies who undergo the French method often need an Achilles tenotomy, as well.

After three months, you’ll likely notice improvement in your baby’s foot. To maintain the correct foot position and prevent clubfoot from coming back, parents often need to continue the regimen until their child is 2 or 3 years old.

Bracing

Your care team may recommend bracing after your baby has finished the Ponseti or French method. Even if those treatments worked, your baby’s foot can move back to the incorrect position. A brace keeps their foot at the correct angle, so it doesn’t move out of position. The brace is usually a pair of shoes with a metal bar connecting them. The brace is often called “boots and bar.” It’s important to:

• Have your child wear the brace every day for three months, then only at night or naps for typically four years.
• Follow the instructions carefully. If your child doesn’t wear the braces when they’re supposed to, their foot may return to the clubfoot position again.

There are several types of braces. Your provider will discuss your options so you can find the right brace for your child.

Surgery

Sometimes, a child has severe clubfoot. Or you’ve tried nonsurgical methods, but they haven’t worked. Surgery can correct the problem. It’s best if your child has the surgery before they start walking. During the procedure, the surgeon:

1. Lengthens your baby’s heel cord and fixes other problems with their foot or feet.
2. Places pins in their foot to correct the position.
3. Puts a cast on their foot after the surgery.

A few weeks after the surgery, the surgeon:

1. Removes the cast and pins.
2. Puts a new cast on your child’s foot, which your child wears for about another four weeks.
3. Removes the final cast.

There’s still a chance their foot could return to the clubfoot position. Your provider may recommend bracing or special shoes to keep their foot in the correct position.

What are the risks of clubfoot surgery?

Risks of congenital clubfoot surgery include:

• Nerve injury.
• Infection.
• Bleeding.
• Stiffness.

Can clubfoot be prevented?

Good healthcare before and during pregnancy gives your child the best chance for a healthy start in life. Even before you’re pregnant, you may want to consider if a preconception checkup is right for you. During this visit, a healthcare provider makes sure you’re as healthy as possible when you get pregnant.

If you’re at high risk for having a baby with clubfoot or other birth defects, talk to a genetic counselor. A genetic counselor is an expert in birth defects and genetic conditions. And get checked for infections such as Zika virus. Treating infections before you become pregnant increases the chances for a healthy pregnancy and baby.

When you’re pregnant:

• Make sure to go to all your prenatal care appointments.
• Protect yourself and the fetus against Zika by using bug spray.
• Don’t smoke or drink alcohol, and only use medications approved by your healthcare provider.

What’s the outlook for babies with clubfoot?

Clubfoot doesn’t go away on its own. Early treatment is essential for a positive outcome. Babies who start treatment early have good results. They can wear regular shoes, walk, run and play without pain. They can even play sports.

If only one foot was affected, you may notice that:

• The affected foot is a smaller size and less mobile than the unaffected foot.
• The calf muscles in the leg with the clubfoot may be smaller.
• Your child may get tired or complain about sore legs sooner than children without clubfoot.
• The affected leg may be slightly shorter. But this usually doesn’t cause major problems.

If your child has another condition along with clubfoot, the outlook may depend on treatment for the other condition.

Can clubfoot return?

Clubfoot can come back. It’s more likely to happen if the treatment schedule wasn’t followed correctly. If the foot returns to the clubfoot position, see your child’s healthcare provider. They can advise you on the next steps. You may need to repeat some stages of the treatment plan.

How can I help my child with their brace?

Regularly wearing the brace gives your child the best chances for success. But it can be challenging for children to wear the brace for so many hours a day. These tips can help parents ease the process of brace-wearing:

• Make it fun: Play with your child when they’re wearing their brace. Do gentle exercises and kicking games. Use the bar to help bend and straighten their knees.
• Make it routine: After the first three months, your child will only need the brace during nighttime and naps. Make the brace part of their sleeping routine. They’ll understand that going to sleep means wearing the brace.
• Add a pad: A soft pad on the metal bar makes the brace more comfortable for your child and yourself. It also has the benefit of protecting furniture and appliances in your house.
• Avoid lotion: Creams or lotions can make skin issues worse. It’s normal if your child’s foot has some redness on it. But blisters may mean the heel is slipping out of the brace. Make sure to firmly strap on the shoes so the foot doesn’t slip. And check your child’s foot frequently to make sure blisters aren’t forming.
• Prevent slippage: Sometimes, the foot keeps slipping out of the brace. Make sure the strap is tight. Double socks may also help keep the shoe firmly on the foot. A physical therapist can recommend other steps to make sure the shoe is snug on the foot.

What else should I ask my child’s healthcare provider about clubfoot?

Ask your child’s provider for a referral to an orthopedic surgeon who specializes in the Ponseti method. This treatment requires a high level of skill and expertise. If your care team recommended the French method, get a referral for a physical therapist who specializes in that method.

Other questions for your child’s provider include:

• When should my baby start treatment?
• What’s the best treatment method for my baby’s clubfoot?
• How long will treatment last?
• Will my child walk normally?
• How can I prevent clubfoot from returning?

A note from Cleveland Clinic

As a parent, when you see that the fetus, or your newborn, has something unexpected, you may wonder about the next steps. You’ve waited for your entire pregnancy thinking about the cute outfits you’d put your baby in — not the casts, splints or braces they’d have to wear. But clubfoot is a common birth defect and treatment is very successful. It’s important to follow the treatment schedule carefully. Doing so increases the chances of success. With the right treatment, many children with clubfoot can walk, run and even play sports without pain. Talk to your child’s healthcare provider about the best therapy method for your child’s clubfoot.