Why Some Infants Have Clubfoot?

​​Clubfoot is a condition that affects children from birth, causing their foot to turn inward and downward. It's a common leg deformity, occurring in about 1 in 1,000 births, and half of the affected children have it in both feet.

The good news is that treatment can begin as early as a week after birth. While mild to moderate cases can often be corrected without surgery, more severe instances may require an operation. Most children treated for clubfoot have an excellent prognosis and can look forward to participating in normal activities, including sports, once their condition has been corrected.

However, it's crucial to address clubfoot early, as untreated cases can lead to lifelong disability, including difficulty walking.

Keep reading to discover more about clubfoot in infants, including its causes, treatment options, and the positive outlook for those who receive timely care.

What causes Clubfoot?

When the Achilles tendon is too short, it leads to congenital clubfoot, causing the foot to point inward. The misalignment of foot bones is a result of the pressure exerted by muscles and tendons on them.

Is Clubfoot passed down through the Parents?

Clubfoot is thought to result from a combination of genetic and environmental influences. This implies that the likelihood of clubfoot is higher if there is a family history of the condition in either parent's lineage. Nevertheless, a family history does not guarantee that a child will be born with clubfoot, and clubfoot can also occur in the absence of any family precedent.

Risk factors for Congenital Clubfoot

Certain factors significantly increase the incidence of clubfoot. For instance, the condition is approximately twice as common in males as in females. Other notable risk factors include:

• A family history of clubfoot: Approximately 1 in 4 people with clubfoot have a family member with the condition.
• Having another genetic health condition: Around 1 in 5 people with clubfoot also have another health concern such as trisomy 18, spina bifida, or muscular dystrophy.
• Diabetes that develops in the pregnant parent: Known as gestational diabetes.
• Lifestyle of the pregnant parent: This encompasses smoking and drinking during pregnancy.

How Does Clubfoot Look?

A child may exhibit either mild or severe clubfoot. Typically, an individual with clubfoot will display the following characteristics:

• One or both feet turning inward and downward
• A pronounced crease on the bottom of the foot or feet
• Deformed or misshapen appearance of the feet
• One leg being slightly shorter than the other
• One calf being less developed, resulting in it being thinner than the other.

Types of Congenital Clubfoot

Clubfoot is categorized into different types, which include:

• Isolated clubfoot, also known as idiopathic clubfoot, occurs without a known cause and is the most easily corrected type.
• Neurogenic clubfoot is caused by neurological conditions such as spina bifida or cerebral palsy, making it more challenging to treat due to these underlying conditions.
• Syndromic clubfoot occurs as a symptom of another non-neurological condition, such as dwarfism or arthrogryposis, making it more difficult to treat because of these underlying health concerns.

Treatment

Clubfoot treatment involves two stages: Ponseti method casting and bracing. Treatment is essential as the condition does not improve as the child grows.

Ponseti Serial Casting

The Ponseti method of serial casting involves gently stretching and manipulating the foot before applying a cast. A week or two after birth, the initial cast is put on, and subsequent casts are changed every seven to ten days at the doctor's office. Around the fourth or fifth cast, a minor in-office procedure is performed to lengthen the Achilles tendon using a local numbing medicine and a small blade. Following this, the baby is fitted with one final cast, which is worn for two to three weeks.

Bracing for Clubfoot

After the foot deformity is corrected by casting, bracing is used to preserve the correction. If bracing is not used, the clubfoot may return. When the final cast is taken off, the infant is provided with a supramalleolar orthosis with a bar. These braces are to be worn for 23 hours a day for two months, followed by 12 hours a day (including naps and nighttime) until the child reaches kindergarten age.

Long-Term Clubfoot Complications

Most children with clubfoot who receive prompt treatment can look forward to a full recovery and an excellent prognosis. They'll be able to walk, wear regular shoes, and even join in sports and other activities just like any other kid. However, there are some potential ongoing complications to be aware of, such as:

- The clubfoot being a size smaller than the other foot

- The affected leg being slightly shorter

- Less-developed calf muscles, which can lead to sore legs or tiredness

- Pain and stiffness, especially after surgery

Life after Treatment of Clubfoot

A properly treated clubfoot appears indistinguishable from a typical foot. Children born with a clubfoot can participate in sports, dance, and wear regular daytime shoes. This condition will not prevent a child from engaging in regular activities.

​References:

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