Clubfoot

Clubfoot has been one of the major orthopedic (bone and joint) problems of children since doctors began to specialize in that field more than two hundred years ago. It is one of the most common of all birth defects, affecting some 9,000 babies (about one in 400) born in the United States each year. Boys are affected twice as often as girls.

What is clubfoot?

Clubfoot is a word used for several kinds of ankle and foot deformities that are usually present at birth. The defect can be mild or severe, and it can happen to one foot or both.

There are three major types of clubfoot:

1. When people say "clubfoot" they usually mean the most severe type, known medically as equinovarus. The foot is twisted inward and downward. If both feet are "clubbed." the toes point toward each other instead of straight ahead. The heel cord often is very tight, making it impossible to bring the foot up to a normal position without a specialist's help.

2. A more common type of clubfoot causes the foot to be sharply angled at the heel, with the foot pointing up and outward. This condition is also easier to manage.

3. In the mildst type, the front part of the foot is turned inward. Although present at birth, this form of defect may not be diagnosed until the baby is a month to a few months old. It is rarely very crippling, and the foot can be treated to look and work better. This helps prevent later problems in fitting shoes.

How does clubfoot affect a child?

Clubfoot is not painful and it doesn't bother the baby until he or she begins to stand and walk. Since the ankle is twisted in place, the foot can't move up and dow-n as it normally would in walking. The child must walk as if he were on a peg leg.

If both feet are affected, the child walks on the balls of his feet or, if the feet are badly twisted, on the sides or even the top part of the feet instead of the soles. The part walked on may become infected, hard, and lumpy, and the entire leg often is unable to grow as it should.

What causes clubfoot?

The exact cause of clubfoot still isn't clear. In the past, it was often thought that the baby's feet were twisted or cramped because of the way the baby lay in its mother's womb. This is true only of cases that correct themselves after birth. Many scientists think the defect starts early in pregnancy, before the baby is large enough to stay in one position very long.

Clubfoot probably is caused by a combination of heredity and other factors that may affect prenatal growth, such as infection, drugs, disease, or other factors in the outside environment.

Although most children with clubfoot have no other birth defects, occasionally there are other deformities as well. Children with spina bifida (open spine) sometimes have a form of clubfoot. This is caused by damaged spinal nerves that affect the legs. In other cases, feet which are normal at birth may become twisted as a result of muscle or nerve disease.

Can clubfoot be cured?

Treatment for clubfoot is started soon after birth. The aim is to force the twisted foot gradually and gently into place so it can move up and down. In some of the mildest cases, parents are taught how to exercise the baby's foot. More often, plaster casts or surgery followed by exercise are needed.

In the usual method of treatment, the doctor turns the foot forward as far as it can go without pain, and puts a plaster cast on to hold it that way. Every few days, at first, the cast is changed to bring the foot closer to normal. After the foot is straightened, it is tilted further upward to stretch the tightened heel cord. It is kept in this over-corrected position for a few weeks to make sure the foot doesn't slip back when the cast is off. It usually takes about three to six months of treatment, with check-ups for many years after.

Some doctors, in certain cases, use adhesive bandaging over a special kind of splint, instead of casts. After the bandages are off, or in some mild forms of clubfoot, the baby sleeps in shoes attached to a metal bar which holds the feet in a corrected position.

Sometimes the heel cord is too tight to be stretched by a cast or bandaging and the doctor must operate to lengthen it.

Immediate treatment for clubfoot with casts or strapping, without surgery, works in more than half of the cases. In others, some form of surgery is part of the overall treatment.

With expert, early treatment, most patients grow up to wear regular shoes, can take part in sports, and lead full, active lives.

Untreated, a clubfoot stays twisted and grows that way. If the defect is treated too late in childhood, surgery may be successful, but the rest of the leg usually can't catch up in growth.

Can clubfoot be

prevented?

Although the crippling effects of clubfoot may often be prevented through early treatment, there is no method of preventing the defect at this time. Genetic counseffig can help parents understand the odds with each pregnancy for having a child with clubfoot and the outlook for treatment.

What research is being

done on clubfoot?

Investigation into the cause and prevention of clubfoot is rarely aimed at the defect alone. It usually is included in scientific studies of birth defects of muscles, nerves and bone in general. The way an unborn baby's muscles and bones grow is affected by so many factors that it will take more years of research to find those that cause clubfoot.

COPYRIGHT 1994 Pediatrics for Parents, Inc.
COPYRIGHT 2004 Gale Group