Clubfoot is the most common congenital foot malformation, occurring in about one in 1,000 births. Also known as congenital talipes equinovarus, clubfoot causes one or both feet to turn in and downward, and remain in this abnormal position without treatment.
Fortunately, clubfoot is highly treatable and children treated are able to walk, run, and participate in normal activities and sports without restrictions, explained Endeavor Health pediatric orthopedic surgeon David Roberts, MD.
Clubfoot is more common in boys than girls, and affects both feet in about 50% of cases. While the cause remains unknown, it is thought to be genetic and may tend to run in some families.
The underlying mechanism involves joint contractures of the bones, connective tissues and muscles of the foot and lower leg, which causes the bones in the foot to become misaligned and the Achilles tendon to be too short.
Diagnosis
With modern technology, most clubfeet are diagnosed before birth on routine prenatal ultrasound.
“We treat a lot of babies with clubfoot and they have great outcomes,” said Dr. Roberts. Most families are now diagnosed prenatally by our colleagues in Maternal Fetal Medicine (MFM), who can refer parents for a consult after the ultrasound.
“Being able to discuss the condition and successful treatment helps allay anxiety for families, and helps parents know what to expect after the baby is born,” he said.
Nonsurgical treatment
Without treatment, a clubfoot remains turned downward and inward, which results in difficulty walking and significant disability. Thankfully, most cases can be corrected with a nonsurgical treatment involving correcting casting, tendon release and bracing.
Clubfoot treatment is known as the Ponseti method, which involves application of corrective plaster casts to the feet to correct the downward and inward position of the clubfoot. This usually starts about one week after the baby is born, when the ligaments, joints and tendons are still very flexible.
Dr. Roberts and fellow Endeavor Health pediatric orthopedic surgeon Angielyn San Juan, DO, are trained in the Ponseti method. The process generally takes six to eight weeks, with new casts put on weekly.
“We actively involve parents in the casting process, helping to sooth their child with a bottle or a pacifier, and use calming music and soothing sounds in the treatment room. Many babies can sleep through the hour-long visit,” said Dr. Roberts.
In the last stage of casting, most babies undergo a small in-office procedure known as a tenotomy, which releases the tight Achilles tendon under local anesthetic. Once the casting is complete, children will wear a special foot brace at night for three or four years.
“It’s so gratifying that this nonsurgical treatment can correct a clubfoot, with most children leading a normal active life with good, strong feet,” said Dr. Roberts.
Weekly casting is a time commitment for families, and diligence with using the brace is important to ensure a good long-term outcome.
Before the Ponseti method was widely accepted, many children with clubfeet were treated with major surgery. In the modern era, this is rare because casting has such a high success rate, said Dr. Roberts.
“These cases are big wins — this common yet serious congenital difference is successfully treated now with correcting casting and bracing, avoiding major surgery in almost all cases. We coordinate closely with our network of colleagues in Maternal-Fetal Medicine, which lets parents know what to expect and is one of the great things about an integrated system like Endeavor Health,” said Dr. Roberts.
