Club Foot (includes Talipes Equinovarus)
Clubfoot includes a group of conditions that are present at birth (congenital) that result in one or both feet to appear bent and twisted at an angle that resembles a golf club. This awkward position of the foot and ankle is not painful, but it is important to begin treating shortly after birth to correct the orientation of the foot so that the child will be ready when he/she is ready to begin walking. Although a clubfoot may affect only one of a child's feet, about half the time both feet are affected. It can be mild, moderate or severe. In more severe cases, the foot can be quite rigid and resistant to manipulation.
Club foot is a relatively common condition that occurs in 1-3 out of 1000 live births. Boys are about twice as likely to have a clubfoot as girls are. Isolated clubfoot can run in families, although much about the underlying genetic elements are not understood. Smoking during pregnancy has also been suggested as a risk factor. Research to better understand the underlying causes of clubfoot is ongoing. Learning more about the underlying causes may provide ways to prevent clubfoot from occurring or recurring (happening again) in families and may lead to even better treatment.
Common Associated Conditions
About 80% of the time, clubfoot is an isolated feature (there aren't any other conditions with it). Even if the clubfoot is isolated, often the affected leg will have a smaller calf muscle and the foot may be shorter than the other foot. About 20% of the time, clubfoot is just one of several features present and may be part of a syndrome. Some studies have found that up to 50% of clubfeet are part of a broader spectrum of features. To rule out this possibility, the baby should be evaluated by a care provider team that includes a medical geneticist and other specialty providers as needed. If the clubfoot is found to be a part of a larger spectrum, additional interventions may be indicated to address and treat these findings.
Short-Term Treatment and Outcomes
Clubfoot is treated either through a process of repositioning the foot into the correct orientation with immobilization and physical therapy, surgical correction to lengthen tendons and ligaments in the foot and ankle, or both. Although your provider will advise you on the best choice for your child's particular situation, in many cases, the first and most conservative approach is to stretch the foot and then immobilize it in the correct position with casts or straps to gently retrain the foot to stay in a more normal position. The foot will need to be repositioned often, (usually once or more per week). It is important to understand that this approach to treatment is slow, but often has a good result. Also, because it is gradual, it will require a strong commitment from the parents to attend at least weekly therapy appointments and to carry out physical therapy exercises at home. Even when all goes well, most individuals with corrected clubfoot will need a procedure called tenotomy of the Achilles tendon as a final step in correcting the clubfoot. In many cases, this procedure can be performed on an outpatient basis and involves partially severing the tendon to allow the calf muscle to stretch out. If the clubfoot is more severe or does not respond well to repositioning correction methods, additional surgical correction may be the recommended.
Long-Term Treatment and Outcomes
Treatment for clubfoot requires a significant commitment to the treatment process over 3 or 4 years. Even when the process goes as planned, there is a chance that the clubfoot will "relapse" and may require a return to stretching, immobilization of the foot by casting and bracing. In some situations, treatment may include additional therapy that may include surgery. Even in the best of circumstances, relapse may occur. As an individual ages, other issues may arise such as arthritis, stiff ankles, or pain.
Sometimes the foot does not respond as well as hoped to correction using stretching, physical therapy, repositioning, casting, and bracing. The muscles of the affected leg may not be as strong or well developed compared to the muscles on the unaffected leg. Tendons and ligaments that are involved in the ankle joint and other joints in the foot may be resistant to lengthening by stretching and may require a surgical intervention.
Implications for Children's Development
In the case of isolated clubfoot, the implications for a child's development can be greatly improved by early, sustained, and dedicated treatment using a stretching, physical therapy, repositioning, casting and bracing approach. Because of the clubfoot, walking may be delayed, but usually catches up as therapy and correction proceeds. Often, people can walk with a relatively normal gait. Into early adulthood, studies looking at longer term outcomes do find that individuals with corrected clubfoot on average experience more pain, weakness, and reduced range of motion in the affected foot compared to controls who were not born with clubfoot. However, these individuals are still highly functional, and the clubfoot does not affect their quality of life.