Health A-Z

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 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.

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.