Clubfoot in Babies and Kids

Clubfoot, also known as congenital talipes equinovarus, is a deformity of the foot present at birth. A baby’s foot is typically twisted out of shape or in a different direction. Tissues (tendons) that connect the muscles to the bone are often shorter than usual as well.

What causes clubfoot?

Clubfoot results from abnormal development of the muscles, tendons and bones in the foot while a fetus is forming during pregnancy. While researchers have not been able to find the exact cause of clubfoot, both genetic and environmental factors may play a role. Clubfoot is about twice as common in boys and occurs in both feet about 50 percent of the time.

How common is clubfoot?

Clubfoot is a fairly common birth defect, occurring in about 1 in 150,000 to 200,000 babies worldwide each year. It is usually an isolated condition for an otherwise healthy newborn, but there are some cases when it can be associated with other medical conditions, such as arthrogryposis or spina bifida. These types of medical conditions are often diagnosed before your child is born.

The following are signs that your child has clubfoot:

• The top of the foot is usually twisted downward and inward, increasing the arch and turning the heel inward.
• The foot may be turned so severely that it looks upside down.
• The affected leg or foot may be shorter.
• The calf muscles in the affected leg are usually not fully developed. 

While clubfoot may look uncomfortable, it doesn’t actually cause any discomfort or pain for a child.

However, treatment is necessary. Nonsurgical treatments may include:

• Casting by an orthopedic provider
• Braces by an orthotist

Why is it important to treat clubfoot?

Without treatment, a child will likely eventually have pain and experience trouble walking and wearing shoes. The best time to start treatment for clubfoot is soon after birth, but treatment can be effective in older children as well.

With early treatment, children with clubfoot can grow up to wear regular shoes, take part in sports and lead full, active lives. If only one foot is involved, the affected foot is generally 1 to 1.5 shoe sizes smaller than the unaffected one, the leg is shorter, and the calf appears slightly thinner. These differences do not affect your child’s ability to use his foot or leg normally.

What is the Ponseti Method?

The gold standard for treating clubfoot is the Ponseti Method and one used by the orthopedic surgeons at Children’s Healthcare of Atlanta. The treatment was developed by Ignacio Ponseti, MD, a Spanish physician. It is minimally invasive and about 95 percent effective.

By applying the Ponseti Method to clubfoot within the first few weeks of life, most cases can be successfully corrected without the need for major reconstructive surgery.

The two phases of the Ponseti Method are:

• Corrective Phase: The feet undergo weekly gentle stretching, followed by long leg casting with the knee at 90 degrees. A child’s normal movements while in the cast allow for further stretching in follow-up visits. Up to 15 percent of clubfoot cases will be fully corrected using this method alone. Others may require an Achilles tendon release, which stops the foot from pointing downward, for a full correction. Following the Achilles tendon surgery, your child will be placed back in a cast for three weeks to allow the tendon to heal.
• Maintenance Phase: Following full correction, your child will be required to wear a foot abduction bar and shoe braces to maintain the correction and prevent recurrence. We often prescribe Mitchell shoes. Initially, most children will wear this brace nearly full time (23 hours a day) for the first three months. Following this period, your child will then wear the brace during nap time and at night until age 4. Without wearing these corrective shoes, the risk for recurrence is extremely high, especially in the first two years.

At Children’s, we usually make two variations to the Ponseti Method: 

1. Most of our doctors use a semi-rigid fiberglass material for the casting instead of the plaster of Paris used by Dr. Ponseti. This material achieves the same results, and it does not require any cutting during removal, which makes removal easier for you and your child.
2. When we perform a heel cord clip, it is performed by an orthopedic surgeon in the operating room under general anesthesia rather than during an office visit under local anesthesia. We feel this procedure is safer in the operating room.

What if my kid needs surgery to treat clubfoot?

For a small percentage of patients, casting may not be effective, so pediatric orthopedic surgery is recommended to achieve correction. Surgical treatment may include:

• Release of soft tissues and joint contractures
• Tendon lengthening
• Temporary use of pins to fix the joints in the foot

Prognosis varies based on the type and extent of surgery. Your pediatric orthopedic surgeon will be able to discuss the details of these surgeries with you if such treatment is recommended.

From our orthopedic surgeons and nurses to our pediatric orthotists and anesthesiologists, the Children’s staff is trained to work solely with kids of all ages—from birth to age 18. Specifically, our Pediatric Orthopedics Program is one of the top programs in the Southeast and ranks nationally on the U.S. News & World Report list of best pediatric orthopedic programs. And if your child requires sedation or anesthesia for treatment, our pediatric-trained anesthesiologists will never leave your child’s side. We can help your child overcome physical, emotional and social barriers and achieve his goals.