Clubfoot

About one in 1,000 babies are born with a clubfoot in which one or both feet are turned inward.

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Symptoms

The foot is turned to the side and, in some cases, the top of the foot appears to be where the bottom should be. The affected foot, calf and leg are shorter and smaller than the other, normal foot and leg. The condition causes no pain, although if it is untreated, it can cause discomfort and disability by the time the baby becomes a teenager.

 

Causes and Risk Factors

Although the causes are unknown, boys are at slightly higher risk than girls for a clubfoot. Clubfoot may also run in families, with the chance of a baby having a clubfoot twice as likely if one of the parents or sibling has the condition.

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Diagnosis

A prenatal ultrasound will often detect a clubfoot even before a child is born. Once a baby is born, parents know immediately that a baby has a clubfoot. One or both feet may be affected.

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Treatments

In the past decade, nonsurgical treatment of clubfoot has greatly improved and, if treated early, surgery can often be avoided. The Ponseti method, which uses a combination of stretching and casting to correct the condition, has become the preferred method of treating a clubfoot. A physician changes a cast every week, each time stretching the foot a little more toward being in the correct position. Once the foot is in the correct position, the child must wear a brace at night for two years so the foot remains in the normal position. Parents must be certain their child wears the brace for the full two years or the muscles of the foot will pull the foot back into the clubbed position. With proper treatment, the baby's foot is usually corrected by the time they are ready to walk.

While the baby is wearing a cast or brace, parents should also pay attention to any changes in skin color or temperature under and around the brace. Any such changes can be a sign of a circulation problem and should be brought to the attention of their physician immediately.

In rare cases, stretching and casting does not correct the abnormal foot position. Surgery is then required to adjust the joints, ligaments and tendons in the affected foot and ankle. Such a procedure is usually performed when the baby is between 9 and 12 months old and corrects all of the problems with the clubfoot at the same time.

After surgery, a cast is used to ensure the foot and ankle remain immobile, allowing them to heal in the proper position. As with nonsurgical treatment, a brace or special shoes need to be worn for up to a year after surgery to ensure the muscle of the foot do not pull it back into an abnormal position. Surgical treatment of clubfoot, while fixing the problem, does often lead to a stiffer joint in later years.

Whether a clubfoot is treated nonsurgically or surgically, the foot, even once corrected, will still be slightly (one of one and a half sizes) smaller than the other foot, may be stiffer and the calf will also remain slightly smaller than the other foot and calf.

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