Clubfoot
Causes
Occasionally children are born with a foot deformity called clubfoot. In this condition, the infant's foot is pointed down and to the inside. The causes of clubfoot are unknown, but it appears that abnormal muscles on the inside of the foot and lower leg tend to pull the foot in too tightly during fetal development. Clubfoot has a tendency to run in families. There is nothing that parents can do to prevent clubfoot, so there is no reason to feel guilty if you have a child with this disorder.
Treatment of clubfoot is generally very successful. Most children will have feet which look normal or close to normal and will be able to participate in sports. If an individual has clubfoot on one side only, the calf muscles and foot on that side will generally stay a little smaller than the opposite side.
Treatment with casts
Clubfoot is treated using a series of plaster casts. On average, infants with clubfoot require the application of an average of 5 to 6 weekly casts. However, some require well over 6 casts. Casting usually starts in the first six weeks of the infant's life; however, treatment can be successful even if it is started later.
Each week or so, the foot is gently molded and a new cast is placed. Casting corrects the inward position of the foot, changing the position a small amount each week. The casts go all the way up the leg so that children can not slip out of the casts or rotate their legs within the casts.
It is very important that you follow the cast instructions below:
- Check circulation
Check the circulation in the foot at least four times a day. This is done by pinching the toes and watching the return of blood. If the toes are dark and cold, the cast may be too tight. If this occurs, call the office. If it is after routine business hours, bring your child to Emergency Department at the hospital or the Emergency Department closest to you to have the cast removed. - See the top of the toes
The top of the toes should be exposed. If you cannot see the toes, the cast has shifted. If this occurs, call the office. If it is after routine business hours, bring your child to Emergency Department at the hospital or the Emergency Department closest to you to have the cast removed. - Schedule a replacement cast
If your child needs his cast removed, call as soon as possible to schedule an appointment to replace it. - Keep the cast clean and dry
The cast may be wiped with a slightly damp cloth if it becomes soiled. Keep the top of the cast outside of the baby's diaper to prevent soiling. - Notify your physicians office if you notice any of the following:
- Any drainage from the cast
- Any foul smells/odors coming from the cast
- If the skin becomes red, sore or irritated
- Cast breakdown or softening
In most children, a small surgical procedure is required after casting to allow the foot to move up and down at the ankle. This procedure, called an Achilles tenotomy, involves cutting the tendon in the back of the heel through a very tiny incision. After the procedure, infants are casted for 2 to 3 weeks while the tendon heals in a lengthened position.
After casting
Following the casting and tenotomy, the feet are braced. There are several types of braces; most consist of two shoes connected by a metal bar. Children wear the brace nearly all the time for 3 to 4 months and then gradually switch to wearing it only while sleeping until they are 4 years old. Using the brace is the most important way to prevent the clubfoot deformity from coming back. Learn more about clubfoot bracing.
Recurrences
About half of children with clubfoot will have some type of recurrence. Often, these recurrences are mild and respond nicely to repeat casting. Some children will need a second tenotomy. About 20 percent of children need surgery to move one the tendons in the foot or to lengthen the Achilles tendon. Less than five percent of patients require major surgery involving the bones and joints because their clubfoot cannot be corrected with casting or because the deformity recurs.