Clubfoot
What is clubfoot?Clubfoot, also known as talipes equinovarus, is a congenital
(present at birth) foot deformity. It affects the bones, muscles, tendons,
and blood vessels and can affect one or both feet. The foot is usually
short and broad in appearance and the heel points downward while the front
half of the foot (forefoot) turns inward. The heel cord (Achilles tendon)
is tight. The heel can appear narrow and the muscles in the calf are
smaller compared to a normal lower leg.
It occurs in about one in every 1,000 live births and affects boys
twice as often as girls. Fifty percent of the cases of clubfoot affect
both feet.
What causes clubfoot?Clubfoot is considered a "multifactorial trait." Multifactorial
inheritance means there are many factors involved in causing a birth
defect. The factors are usually both genetic and environmental.
Often one gender (either male or female) is affected more frequently
than the other in multifactorial traits. There appears to be a different
"threshold of expression," which means that one gender is more likely to
show the problem than the other gender. For example, clubfoot is twice as
common in males as it is in females. Once a baby has been born with
clubfoot, the chance for it to happen again in a male or female child is
about 4 percent overall. In other words, there is a 96 percent chance that
another baby would not be born with clubfoot.
What are the risk factors for clubfoot?Risk factors may include the following:
- family history of clubfoot
- position of the baby in the uterus
- increased occurrences in those babies with neuromuscular disorders,
such as cerebral palsy (CP) and spina bifida
- oligohydramnios (decreased amount of amniotic fluid surrounding the
fetus in the uterus) during pregnancy
Babies born with clubfoot may also be at increased risk of having an
associated hip condition, known as developmental dysplasia of the hip
(DDH). DDH is a condition of the hip joint in which the top of the thigh
bone (femur) slips in and out of its socket because the socket is too
shallow to keep the joint intact.
How is clubfoot diagnosed?Your baby's physician makes the diagnosis of clubfoot at birth
with a physical examination. During the examination, your baby's physician
obtains a complete prenatal and birth history of the baby and asks if
other family members are known to have clubfoot. If the diagnosis of
clubfoot is made in an older infant or child, the physician will also ask
about developmental milestones since clubfoot can be associated with other
neuromuscular disorders. Developmental delays may require further medical
follow up to evaluate for underlying problems.
Diagnostic procedures of the foot may include:
- x-ray - a diagnostic test which uses invisible
electromagnetic energy beams to produce images of internal tissues,
bones, and organs onto film.
- computed tomography scan (Also called a CT or CAT scan.) - a
diagnostic imaging procedure that uses a combination of x-rays and
computer technology to produce cross-sectional images (often called
slices), both horizontally and vertically, of the body. A CT scan shows
detailed images of any part of the body, including the bones, muscles,
fat, and organs. CT scans are more detailed than general x-rays.
The affected foot may be flexible, known as a "positional clubfoot."
This flexible type of clubfoot is caused by the baby's position in the
uterus. Positional clubfoot can easily be positioned into a neutral (not
curved) position by hand. A true clubfoot is stiff, or rigid, and very
hard to manipulate.
The symptoms of clubfoot may resemble other medical conditions of the
foot. Always consult your baby's physician for a diagnosis.
Treatment for clubfoot:Specific treatment for clubfoot will be determined by your
baby's physician based on:
- your baby 's gestational age, overall health, and medical history
- the extent of the condition
- your baby's tolerance for specific medications, procedures, or
therapies
- expectations for the course of the condition
- your opinion or preference
The goal of treatment is to straighten the foot so that it can grow and
develop normally. Treatment options for babies include:
- serial manipulation and casting
Treatment begins immediately after diagnosis by a pediatric orthopaedic
surgeon. The first type of treatment is serial manipulation and casting.
Your baby's physician will stretch the foot by hand. The position of the
foot is then held in place with plaster casts. Casts are used to help
stretch the soft tissues of the foot. Your baby's physician will change
the plaster casts every week for the first month, then every two weeks
until the foot is straight. The foot usually responds to this type of
treatment within the first few months. If the position of the foot does
not respond to serial manipulation and casting, then surgery may be
considered. Only about one-third of clubfeet are able to be managed with
serial manipulation and casting alone.
- surgery
Ideally, surgery is performed within six weeks to one year of diagnosis.
The foot is aligned in a more normal position. A pin is placed in the
foot to hold the bones in place while they heal. The pin can be seen
between the big and second toes. Following surgery, long leg plaster
casts are applied to hold the foot in place as it heals. The long leg
cast and pin are removed usually three to four weeks after surgery by
your baby's physician. Short leg casts will continue to be used for at
least three more months to continue to hold the foot in place and allow
the tissues and bones to heal.
What are long leg casts?Long leg casts are applied from the upper thigh to the foot.
These casts are used for thigh, knee, or lower leg fractures. They can
also be used with knee dislocations or after surgery on the leg or knee
area.
What are short leg casts?A short leg cast is applied to the area below the knee to the
foot. This type of leg cast is used for leg fractures and severe ankle
sprains/strains or fractures. A short leg cast may also be used to hold
the leg or foot muscles and tendon in place after surgery to allow
healing.
Cast care instructions:
- Keep the cast clean and dry.
- Check for cracks or breaks in the cast.
- Rough edges can be padded to protect the skin from scratches.
- Do not scratch the skin under the cast by inserting objects inside
the cast.
- Use a hairdryer placed on a cool setting to blow air under the cast
and cool down the hot, itchy skin. Never blow warm or hot air into the
cast.
- Do not put powders or lotion inside the cast.
- Cover the cast during feedings to prevent spills from entering the
cast.
- Prevent small toys or objects from being put inside the cast.
- Elevate the cast above the level of the heart to decrease swelling.
When to call your baby's physician:Contact your physician if your baby develops one or more of the
following symptoms:
- fever
- increased pain
- increased swelling above or below the cast
- drainage or foul odor from the cast
- cool or cold toes
Long-term outlook for a baby with clubfoot:
Some babies with clubfoot will be corrected with serial manipulation and
casting. Other babies may require surgery to help correct the position of
the foot. Additional surgeries may be necessary since the deformity may
come back as the child grows and develops.
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