Clubfeet

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Clubfeet or club foot is a congenital, deformity of one foot or both, as well as, the ankle. The most common positions include the following variations:

  1. A bending inward of the foot, 2) A bending outward of the foot, 3) A plantar flexion, in which the front of the foot is bending downward (toes are lower than the heel) and 4) A dorsiflexion, in which the front of the foot is bending upward and 5) Toes lower than the heel and turning inward.

Most cases are a combination of these positions. This condition may occur as an isolated deformity or may be a part of a syndrome or other disorders, such as cerebral palsy or spina bifida. The incidence of occurrence in our population is 1 in 1000 live birth. It typically affects boys 2 times more than girls and 50% of the cases, it involves both feet. The cause of the deformity is not certain, but there are two schools of thought in what causes it. Some experts seem to believe this deformity it the result of abnormal positioning and restricted movement of the baby in the uterus. Others seem to believe in an abnormal development at the cellular level, while in utero.

Diagnostic Evaluation

This type of deformity is readily apparent and is sometimes diagnosed before birth via ultrasound. However, it does require classification in order to determine the treatment plan for correcting it, whether it is corrected with or without surgery.

Classification and Treatment

Clubfoot is divided into 3 subcategories. The positional clubfoot ( also known as, postural or transitional clubfoot), is the milder form of clubfoot and is believed to be the result of intrauterine crowding. This can sometimes be corrected by simple stretching and applying a cast (serial casting). There are cases where this type of clubfoot has corrected spontaneously (on its own). The clubfoot deformity associated with other birth defects or associated with a syndrome (syndromic or teratologic clubfoot), is a more severe form of clubfoot and is usually resistant to simple stretching exercises and casting. It will require surgery to correct it. And the third class of clubfoot, known as idiopathic clubfoot requires surgery to correct it because this type of clubfoot usually has some type of bone abnormality.

Therapeutic Management

Now, the goal of treatment is three pronged in nature. First of all you want it to be as painless, as possible. Secondly, you want a plantigrade or flat foot and lastly, you want a stable foot. It also involves three stages, as well: 1) Correcting the foot deformity, 2) maintaining that correctness, as well as, accomplishing normal muscle balance, and 3) follow-up examinations by the Doctor to prevent the deformity from coming back.

The most common method is to begin placing the leg and foot into a long leg cast, as soon as possible, after birth. It will involve periodic manipulation of the foot and reapplying another cast, otherwise known as, serial casting. Sometimes, cutting of the tendon at the heel, or tenotomy is required to achieve normal foot alignment. Sometimes, the child’s foot or feet, may be placed in specially made shoe or sandal for a period of time, determined by the Doctor, in order to prevent reoccurrence of the deformity. If the approach does not achieve the goal of normal foot alignment, then more extensive surgery may be required.