Clubfoot

SSM Health Cardinal Glennon Children’s Hospital has a dedicated Clubfoot Program in the Division of Pediatric Orthopedic Surgery. The program offers comprehensive evaluation as well as both nonsurgical and surgical treatment options to correct deformities. Because clubfoot is most often diagnosed before a child is born, our specialists work closely with fetal specialists to monitor the condition and the begin treatment within a few weeks of birth.

What is Clubfoot?

Clubfoot is one of the most common orthopedic birth defects, affecting about one in every 1,000 children. It is an inward turning of a baby’s foot to the point that the bottom of the foot actually faces sideways or, in some cases, turns upward to the point that the foot actually almost looks like it’s upside down.

Clubfoot is often diagnosed during as early as 13 weeks into pregnancy by a routine prenatal ultrasound. In about half of all cases, both feet are turned inward. If not treated early, children will likely have walking problems and develop blisters or sores on the side of the foot that touches the ground. Bone infections or arthritis also can develop over the long-term.

What Causes Clubfoot?

The condition, also known as talipes equinovarus, occurs when tendons and/or ligaments connecting the foot bones with the leg muscles are too tight or if the leg muscles are shorter than normal.

In some cases, the cause can’t be determined; however, clubfoot can be caused by genetic or environmental factors.

• Oligohydramnios – temporary, positional clubfoot can occur when an expecting mother develops oligohydramnios, a condition in which there is too little amniotic fluid. This type of clubfoot is temporary and often rotation and then stretching after delivery can fix the malrotation.
• Genetics – If a parent was born with a clubfoot, their child has a 25% risk of developing the same condition. If there is no family history and parents have one child with clubfoot, there is a slight risk (3%) that a subsequent child will be born with the same condition.
• Other Medical Conditions – there is a chance that clubfoot can develop in children with neuromuscular disorders such as spina bifida or arthrogryposis. If this is suspected, your doctor may recommend genetic testing after birth.

Treatment

As soon as clubfoot is diagnosed, a team of SLUCare Physician Group specialists will monitor both the health of the mother and the baby. The team includes maternal-fetal medicine specialists, a pediatric orthopedic surgeon, sonographer, genetic counselor, and social worker.

There is no specific need for a cesarean section and delivery will not likely be impacted by a clubfoot diagnosis. Once your child is born, our pediatric orthopedist will fully evaluate your baby to determine next steps. Clubfoot can either be mild or severe and treatment options are guided by the extent of the twisting or rotation.

Ponseti Method

The most widely used treatment for clubfoot is the Ponseti Method, which uses gentle repositioning and stretching of the foot along with casting to gradually correct the problem. The treatment begins when your newborn is 2-3 weeks old because this is the time when a baby’s joints and tendons are most flexible. Your baby’s foot (or feet) will be gently stretched and then rotated into a corrected position. The leg is then held in that position with a full leg cast that runs from the thigh to the toes. Your baby will return weekly for regular stretching, positioning, and re-casting for the next 6-8 weeks until the foot is moved into the most natural position.

Achilles Tenotomy

In about 90% of cases, babies will also need to have a minor procedure to release the tightness that occurs in the Achilles tendon, the tendon on the back of the ankle that connects the calf muscle to the heel bone. A new cast will then be placed to protect the tendon as it heals, which takes approximately 3 more weeks. Over that timeframe, the tendon will regrow to a longer, more proper length.

Customized Bracing

Key to successful clubfoot treatment is patient/parent compliance with the use of braces over several years after the foot has been repositioned. Clubfeet have a natural tendency to recur. To stop the foot from moving back to the abnormal position, your baby will need to wear a customized brace and shoes (commonly called “boots and bar”) to keep the foot at the proper angle as the legs, tendons and ligaments grow. Initially, braces are worn 23-24 hours a day. Your orthopedist will gradually decrease the amount of time to just while sleeping (overnight and during naps). The full bracing process lasts for 4-4.5 years, with it typically ending the summer before kindergarten.

In rare cases, additional surgery may be recommended. Your orthopedist can discuss that with you if needed. Once proper treatment is completed, children should be able to walk and stand freely and participate in normal activities.