Clubfoot is a congenital condition (present at birth) that causes a baby’s foot to turn inward or downward. It is known as talipes equinovarus (TEV) or congenital talipes equinovarus (CTEV). About one out of every 1,000 babies is born with a foot that’s twisted. In 50 percent of cases, both feet are affected. It can be mild or severe and occur in one or both feet. Clubfoot is one of the most common congenital birth defects.
Usually, a baby born with a clubfoot is otherwise healthy with no additional health problems. It is not a painful condition for your baby still treatment should begin a week or two after birth. Correction methods vary from manual foot manipulation over time to surgically fixing the foot.
There are two types of clubfoot:
• Isolated or idiopathic clubfoot is the most common type. If your child has clubfoot with no other medical problems, it’s called isolated clubfoot. Idiopathic means that the cause of clubfoot is not known.
• Nonisolated clubfoot happens along with other health problems. These conditions include arthrogryposis (a joint problem) and spina bifida (a neural tube disorder). Neural tube defects are problems of the brain, spine and spinal cord.
The symptoms of clubfoot vary but are easy to identify by doctors.
The most common sign of clubfoot is one or both feet turning inward. The foot faces the opposite leg.
One may also notice that the foot has a –
• Kidney shape.
• Deep crease on the inside mid aspect of the foot.
• Higher arch than normal (called cavus foot deformity).
More symptoms are as follows –
• A foot that turns inward and downward, with toes pointing toward the opposite foot.
• The clubfoot may be smaller than the other foot (up to ½ inch shorter).
• The heel on the clubfoot may be smaller than normal.
• In severe cases, the clubfoot may be twisted upside down.
• The calf muscle on the leg with the clubfoot will be slightly smaller.
• If only one foot is affected, it is usually slightly shorter than the other, especially at the heel
Clubfoot is mainly idiopathic, which means that the cause is unknown. Genetic factors are believed to play a major role, and some specific gene changes have been associated with it, but this is not yet well understood.
☆ It is not caused by the fetus’ position in the uterus.
Sometimes it may be linked to skeletal abnormalities, such as spina bifida cystica, or a developmental hip condition known as hip dysplasia, or developmental dysplasia of the hip (DHH).
It may be due to a disruption in a neuromuscular pathway, possibly in the brain, the spinal cord, a nerve, or a muscle.
Risk Factors –
Boys are about twice more prone to develop clubfoot than girls.
Risk factors include:
• Family history.
If either of the parents or their other children have had clubfoot, the baby is more likely to have it as well.
• Congenital conditions.
In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth (congenital), such as spina bifida, a birth defect that occurs when the spine and spinal cord don’t develop or close properly.
Smoking, drinking alcohol or using illegal drugs during pregnancy can significantly increase the baby’s risk of having such defect.
• Not enough amniotic fluid during pregnancy.
Too little of the fluid that surrounds the baby in the womb may increase the risk of having such a problem.
Babies need treatment to correct the problem before they reach walking age.
Untreated clubfoot can lead to –
• Walking problems. Babies with clubfoot often walk in unusual ways. Typically, people walk on the bottoms and soles of their feet. A baby with clubfoot may walk on the sides and tops of the feet.
• Foot infections.
• Foot problems, including calluses. A callus is a thick layer of skin that often develops on the sole of the foot.
• Arthritis, a joint condition that causes pain, stiffness and swelling.
Foot imbalance due to clubfoot may be noticed during a fetal screening ultrasound as early as 12 weeks gestation, but the diagnosis of clubfoot is confirmed by physical exam at birth.
There are several methods for treating clubfoot. Health professionals team will discuss the options with you and figure out which works best for your child. Treatments include:
• Ponseti method
The Ponseti technique of serial casting is a treatment method that involves careful stretching and manipulation of the foot and holding with a cast. The first cast is applied one to two weeks after the baby is born. The cast is then changed in the office every seven to 10 days. With the fourth or fifth cast, a small in-office procedure is also needed to lengthen the Achilles tendon. This is done using a local numbing medicine and small blade. Afterward, the baby is placed into one last cast, which remains on for two to three weeks.
• French method
This method also stretches but uses splints for the leg to correct the curve.
This method uses special shoes to keep the foot at the proper angle. While the casting corrects the foot deformity, bracing maintains the correction. Without bracing, the clubfoot would redevelop. The day the last cast is removed, the baby is fit in a supramalleolar orthosis with a bar. These braces are worn 23 hours a day for two months, then 12 hours a day (naps plus nighttime) until kindergarten age.
It may be an option if other methods don’t work.
A well-corrected clubfoot looks no different than a normal foot. Sports, dance and normal daytime footwear are the expectations for a child born with a clubfoot. This condition will not hold a child back from normal activities.
For more informative articles about birth defects and other health related issues, please visit our website www.santripty.com and also feel free to consult.