Clubfoot

What is clubfoot?

Clubfoot is a foot abnormality in which a baby’s foot is completely twisted in terms of its shape and position. It can affect one or both feet. In this condition the baby’s foot appears to be rotated internally at the ankle. It appears in such a way that the bottom of the foot faces sideways or even upward. In clubfoot the tendons which connect the leg muscles to the foot bones are short and tight, causing the foot to twist inward.

Clubfoot is quite common affecting 1 in every 1000 babies. The condition is not painful during birth or infancy. However treatment must be initiated soon to prevent mobility issues.

Classification

Clubfoot is classified into

1. Isolated (idiopathic) clubfoot: In this type, the children have no other medical problems except foot deformity.

2. Non isolated clubfoot: This happens when the disease is seen with other health conditions like spina bifida or other neuromuscular problems. This type of clubfoot requires longer duration of treatment.

Symptoms of Clubfoot

Following are the symptoms of clubfoot

The top of the foot twists downwards and inwards

The foot appears to be sideways or upside down

The arch is more prominent and the heel turns inward

When compared to a normal foot, the affected foot appears to be smaller (upto half inch)

The calf muscles seems to be underdeveloped

The foot is supposed to have limited range of motion but a person with clubfoot usually will not feel the pain while walking. 

Causes of clubfoot

Clubfoot could be due to genetic and environmental factors.

1. Genetic factors: If either of the parents has clubfoot, the probability of the baby inheriting the disease is 1 in 30. If both parents possess the condition, the risk increases upto 1 in 3. If a mother has one child with clubfoot, her chance of having a second child with the disease may be 1 in 35.

2. Gene mutation: Mutations in PITX1 gene may be responsible for this defect. This gene is vital for the development of lower limbs.

3. Gender: Males are twice affected compared to females.

4. Environmental factors: Smoking and usage of illegal drugs during pregnancy significantly increases the risk of clubfoot.

5. Amniotic fluid: Very little amount of amniotic fluid may increase the risk of clubfoot.

Diagnosis of clubfoot

Clubfoot can be diagnosed during an ultrasound that is performed during 18 to 21 weeks of pregnancy. But no treatment is possible until the baby is born. More investigations are performed to check whether the condition is associated with spina bifida or muscular dystrophy. Parents can be in touch with a pediatric orthopedic surgeon to start treatment soon after the baby is born.

A doctor usually identifies clubfoot soon after the birth of a baby. In some cases, the severity of the deformities is understood by performing an x-ray.

Treatment of clubfoot

The aim of the treatment is preventing long term disabilities and improving the way the foot looks. Since a newborn’s joints and tendons are very flexible, treatment is initiated during the first two weeks of birth of the baby. There are two main treatment modalities: Stretching and casting, and surgery.

Stretching and casting:

The Ponseti method: In this method, the baby’s foot is manipulated by placing it in a cast. The intention is to correct the bend in the foot. A plaster cast is applied from the toes to the thigh, to hold the foot in position. This procedure is done once a week. The casting process is performed very gently so that the baby does not feel any pain. The session is repeated every week, and during each visit, the cast is changed and the foot is corrected gradually. Approximately 4 to 10 casts will be required. This casting will be followed by a minor surgery to release the Achilles tendon.

Once the foot is corrected, the patient is advised to wear boots attached to a brace to hold the foot in the best possible position and to prevent further relapse. For the first three months, the boots are worn 23 hours a day, then only during night times and day naps (till four years of age). Parents must follow the doctor’s instructions and the braces should be worn appropriately.

The French method: This method involves daily stretching, exercise, massage, and immobilization of the foot with nonelastic tape. This procedure is carried out by a physical therapist for a period of three months. Then the taping and splinting process will be continued until the infant reaches 2 years. 

Surgery:

If the non-surgical procedures do not work, surgical procedures will be done. Surgery aims at correcting and repositioning the tendons, ligaments, and joints in the foot and ankle. The Achilles tendon is released by moving the tendon that goes from the front of the ankle to the inside of the foot. The surgery is then followed by a casting process. The disadvantage of surgeries is overcorrection of joints, which can lead to arthritis in later stages of life.

Complications of clubfoot

A child may feel some difficulties in walking and some flexibility issues.

Precautions

Since the exact reason for clubfoot is poorly understood, preventive measures can be quitting smoking, alcohol and drugs during pregnancy.