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Congenital Clubfoot

Congenital Clubfoot fundamentals

Congenital clubfoot is present at birth (the definition of "congenital") and affects the foot and/or ankle. There is no known cause for clubfoot, and it is twice as common in male children as it is in female children. The frequency of congenital clubfoot is approximately 1 per 1,240 live births. In children with clubfoot, there is a subtle imbalance in muscle forces in the lower leg resulting in the foot deformity. Often, the foot is "kidney-shaped." About 50 percent of the time, both feet are affected with clubfoot.

Although there is no known cause for congenital clubfoot, some doctors believe the use of drugs or alcohol during pregnancy or the presence of other diseases can cause it.

Until recently, 85 percent of children with congenital clubfoot required extensive surgery to correct their deformity. Now 90-95 percent can be corrected without surgery or with minor procedures using a new casting technique.

What are the symptoms?

Although different types of clubfoot exist, the condition is usually accompanied by the following foot deformities:

  • Plantar flexion: Twisting of the ankle.
  • Cavus foot deformity: An unusually high arch in the foot.
  • Varus: An inversion of the heel that causes the front of the foot to turn inward.
  • Adduction of the forefoot: the forefoot is pulled downward.

Other symptoms include:

  • Stiffness in the ankle or foot tendons
  • One calf appears shorter than the other
  • Affected foot lacks full range of motion

What is the treatment?

It is vital to treat congenital clubfoot as soon as it is diagnosed in order to minimize problems down the road. The probability of correcting the condition is highest if treatment is begun during the first two weeks of the child’s life.

Medical Treatments

In some cases, clubfoot can be corrected via exercise, stretching of the heel cord and casting. Corrective casting employs gentle stretching of the foot with application of a holding cast to maintain corrected position. The manipulation and casting are repeated on a weekly basis until the deformity is either corrected or the degree of correction plateaus.

Surgical Treatments

Surgery for children with congenital clubfoot is best done prior to walking age as walking then will not be significantly delayed. The goal of surgery is to lengthen the heel cord and correct the forefoot and hindfoot. Clubfoot surgery can be performed after 1 year of age, however results typically are less satisfying.

What are the risks of surgery?

Risks of congenital clubfoot surgery include nerve injury, infection, bleeding, and stiffness.

How does my child prepare for surgery?

  • Complete any pre-operative tests or lab work prescribed by your child’s doctor.
  • Do not allow your child to take aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your child’s appointment time. If the clubfoot surgery is being done at Cleveland Clinic, call 216.444.0281.
  • Refrain from eating or drinking anything after midnight the night before surgery.

What does my child need to do the day of surgery?

  • If your child currently takes any medications, have her or him take them the day of the surgery with just a sip of water.
  • Do not allow your child to wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
  • Have your child wear loose-fitting, comfortable clothing.

What happens after surgery?

Ask your surgeon for complete post-operative instructions.

How long is the recovery period?

Typically the foot is immobilized in a cast for six to eight weeks after surgery at which time the cast is removed and motion exercises are begun.

What is the rehab after surgery?

Because congenital clubfoot can relapse over time, it is important to monitor the condition, especially during the first two or three years of children's lives. Special shoes are necessary until age 3 or 4 to prevent relapse.

How will my child manage at home during recovery from surgery?

Your surgeon will provide you with home-going instructions.

How frequently should I schedule follow up appointments with the doctor following surgery?

Your surgeon will advise you regarding post-operative appointments.

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