Clubfoot, also known as Congenital Talipes Equinovarus (CTEV) or talipes, is an innate developmental disorder that can affect one (unilateral) or both (bilateral) feet.
A normally developed foot becomes a clubfoot in the second trimester of pregnancy. Diverse soft tissues in the lower leg develop differently, resulting in short muscles and tendons and stiff ligaments. This affects the positions of the bones in the feet, giving it the following characteristics that are present at birth:
- Cavus: the midfoot has a high arch.
- Adduction: the forefoot turns inwards in relation to the hindfoot.
- Varus: the hindfoot (heel) turns inwards in relation to the lower leg.
- Equinus: the foot pointing downward.
How often does clubfoot occur?
Clubfoot is one of the most common birth defects, affecting 150.000 -200.000 newborns each year. Boys are more often affected than girls and in 50% of the cases the condition is bilateral, affecting both feet. Only a small minority of the families has acces to proper treatment and the support they need to end the disability the clubfeet causes.
What causes clubfoot?
In most cases, the exact cause of the disorder remains unknown. These feet are called idiopathic or isolated clubfoot. In a small minority of cases clubfoot occurs in combination with chromosomal or genetical abnormalities or syndromes. This is called syndromic clubfoot.
Clubfoot can run in families: in 25% of the cases, there is a family history with clubfoot. Scientific studies suggest genetics and environmental factors also play a role in the development of clubfoot.
Treatment: the Ponseti method
The deformity of the foot will not correct itself: treatment is needed. Without proper treatment, clubfoot causes lifelong pain and disability. Both in the present and past, different methods are used but nowadays the Ponseti method is worldwide recognized as the golden standard for clubfoot treatment. Compared to other techniques, it has the best long term outcomes , achieving fully functional, pain-free feet in over 90% of cases.
Clubfoot treatment using the Ponseti Method consists of three phases:
- Correction. The Ponseti method uses very specific and gentle manipulations to align the foot in a more normal position and casting to allow the soft bones to “set”. Usually, about five to seven weekly casts, extending from the toes to the upper thigh and the knee at right angle are needed to fully correct the feet. Before applying the last cast, in most cases the Achilles tendon is cut (tenotomy) to achieve full correction. This last cast stays on for three weeks, after which the tendon is fully healed and the feet are ready to start wearing the brace.
- Prevention of Relapse. Clubfoot has a strong tendency to relapse. To prevent that, a foot abduction brace has to be worn following initial correction. The brace consits of two sandals attached on a bar. The brace has to be worn fulltime for the first three months, after that at sleep- and naptimes until the child reaches at least four years of age.
- Surveillance. Your child will have regular visits until fully grown to monitor how the legs and feet are growing. Keep in mind that all children are different and length of treatment may vary.
In only a small minority of cases, less then 5%, the deformity is more severe and might need surgical correction. Results are best if bone and joint surgery is avoided all together, because it causes scarring, stiffness and muscle weakness that becomes more severe over time.
Finding out your child has clubfoot can be scaring and overwhelming. It is good to realize you have done nothing wrong that cause the feet and that with proper, painfree treatment your child will be able to lead a normal and active life.