What Is Clubfoot, And How Can This Foot Deformity Be Treated?

Clubfoot is a foot abnormality that can look scary — so parents who have just been told that their (unborn) baby suffers from this condition may well be extremely worried about what the prognosis for their baby is. Thankfully, clubfoot does not lead to pain in infants. Starting treatment immediately offers extremely good outcomes, to the point that the baby will not experience any mobility impairments later in life and the fact that they were born with clubfoot will barely be noticeable. 

What Is Clubfoot?

Clubfoot sounds rather descriptive, and its name actually comes from the way in which the foot can twist outwards, making it look somewhat like a golf club. It is, however, a term used to describe a range of abnormalities of the foot, rather than a single condition. Usually present at birth, clubfoot can present in a number of ways. The foot is typically shorter than usual, particularly at the heel, and the calf muscles are underdeveloped. The foot may point towards, point inwards towards the other foot, or even point up. Clubfoot can be unilateral or bilateral, and in about half of all cases both feet are affected. 

What Causes Clubfoot?

The causes of clubfoot — also called talipes equinovades — are still unclear. While some medical professionals still hold that it can be caused by something as simple as fetal malpositioning, most agree that this isn't possible. Since clubfoot is more likely to occur in babies born to families with a history of the condition, it's clear that there is a genetic component. Environmental factors are also thought to contribute. 

How Is Clubfoot Diagnosed?

Unless clubfoot wasn't present at birth, the condition will be immediately visible after a baby's birth — and it can also be spotted on ultrasound scans during pregnancy. In the latter case, more detailed ultrasounds may be recommended to see if the baby has a case of nonisolated clubfoot, meaning other neuromuscular conditions that have better outcomes with prenatal diagnosis are also present.

Once a baby has been diagnosed (and born), X-rays can offer insight into the degree of the condition. No prenatal treatments are currently available for clubfoot.

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Though painless at birth, clubfoot can lead to severe mobility issues if left untreated. That's why starting treatment as soon as possible is of paramount importance. A variety of treatment methods are available, and babies born with clubfoot will not need surgery to correct the condition in most cases. We'll discuss the treatment options and outcome on the next page.

Clubfoot Treatment Options

Clubfoot can be treated in a variety of ways. Let's look at the options and their pros and cons. 

The Ponseti Method

The Ponseti method is, globally, the most popular treatment option for clubfoot.This method is characterized by gentle stretching exercises and the use of a plaster cast to gradually alter the position of the foot. Starting very soon after birth, the process involves stretching exercises that will work towards reaching a correct position, followed by applying a plaster cast that reaches from foot to thigh. This process is performed in a weekly basis until the foot finds itself in an optimal position. 

Once the foot has reached the correct position, many babies will need a minor surgical procedure called an Achilles tenotomy to release the tight tendon that so many babies with footclub have.

Once these procedures are complete, patients will require braces to ensure that the feet stay in the correct position and no relapses occur. People born with clubfoot which was subsequently treated with the Ponseti method will usually need to wear these braces for a few years. The Ponseti method has proven to be extremely successful, correcting clubfoot in 90 out of 100 babies.

The French Method

As with the Ponseti method, the French method (also called the French functional method) of treating clubfoot relies on stretching exercises. These are performed between three and seven days a week, and then taped — often with a splint to ensure progress is maintained. Babies being treated with the French method will usually need a tenotomy just like those treated with the Ponseti method, and the treatment is likewise commenced shortly after birth. However, the treatment regime is maintained until a child is two to three years old, rather than following two different steps — casting and bracing.

Surgery For Clubfoot

Non-surgical treatment for clubfoot can be very successful indeed, but sometimes the deformities are so severe that surgery is required. Non-surgical treatments can also fail because families find following the rigorous routine difficult. Even where surgery is required, having undergone treatment according to the Ponseti or French method will often have lessened the extent of the deformity, making the subsequent surgery less extensive. 

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With treatment, the child's foot is likely to be quite a bit smaller than average, and their mobility may be slightly affected. However, most kids who started treatment shortly after birth will be able to walk and run without difficulties or pain. Leaving clubfoot left untreated is not a good option. It can result in immobility or reduced mobility as well as arthritis, muscle problems, and social and self-confidence problems.