Clubfoot in Children

Clubfoot is a common congenital (present at birth) condition that affects the bones, muscles, tendons and blood vessels. This condition is not painful. However, clubfoot can make it harder for a child to walk without a limp and may lead to further medical issues if it is not treated.

At Banner Children’s, our caring team can help. Learn more about clubfoot and available treatment options.

What is clubfoot?

Clubfoot, also known as congenital talipes equinovarus, is a foot abnormality that causes one or both feet to turn inward. Instead of being straight, a baby’s foot turns toward the opposite leg and the heel points down.

Clubfoot can range from mild to severe. It is estimated that clubfoot affects nearly 7,000 babies in the United States each year and is twice as common in boys as in girls. About half of all babies with clubfoot have it on both feet.

What causes clubfoot?

The exact cause of clubfoot is uncertain. Most cases occur in newborns with no other health problems. However, experts believe the condition has a genetic component (runs in families) or may be caused by things in your environment.

The three main types of clubfoot are idiopathic, neurogenic and syndromic:

• Idiopathic clubfoot: The most common type of clubfoot that occurs in babies with no other health problems.
• Neurogenic clubfoot: This is caused by a neurological condition that affects the brain, spinal cord and nerves. Neurogenic clubfoot can occur in a child born with spina bifida, cerebral palsy or spinal cord compression.
• Syndromic clubfoot: This happens in newborns with a musculoskeletal conditions such as arthrogryposis (limited range of motion in the joints), amniotic band syndrome (when bands of tissue from the amniotic fluid sac tangle around a fetus) and dwarfism.

A baby may be at higher risk for clubfoot if they have a genetic condition, like Trisomy 18 (Edwards syndrome). A pregnant person may also be at higher risk of having a baby with clubfoot if they catch the Zika virus, have oligohydramnios (not having enough amniotic fluid to support the baby in the womb) or smoke, drink or use illegal drugs during pregnancy.

What are the signs of clubfoot?

The most common sign your child has clubfoot is one or both feet turn in toward the other leg.

Other problems you may notice include:

• The clubfoot has a high arch 
• There is a deep crease in the bottom of the clubfoot
• The affected leg is shorter
• The calf muscle is smaller in the affected leg
• There is stiffness or tightness in the affected foot

How do I know if my child has clubfoot?

Most of the time, a baby’s clubfoot is diagnosed during a prenatal ultrasound before birth. This typically occurs around the 20th week of pregnancy. Early diagnosis allows parents time to connect with specialists (such as pediatric orthopedists and physical therapists) who can treat the condition once your baby is born. If clubfoot is not found during pregnancy, it can be diagnosed during the first physical exam after your child is born. Your child’s health care provider may sometimes recommend an X-ray to confirm the diagnosis

How is clubfoot treated?

Clubfoot treatment starts soon after birth, often as early as one week old. With early treatment, your child can go on to have an active life and walk, run and play without pain.

The goal of treatment is to move the position of the foot (or feet) gradually and gently so that it can grow and develop normally. Most children with clubfoot can be treated without surgery. Your child’s health care provider can help you choose the best treatment for your baby.

Clubfoot treatments may include:

• The Ponseti method - the most popular form of clubfoot treatment worldwide - which uses gentle stretching and casts to gradually correct the position of the foot (or feet).
• The French method, which uses splints and taping instead of casts.
• Braces or special shoes to keep the foot at the proper angle. This may be recommended after your baby has finished the Ponseti or French method.
• Surgery, which may be an option if other methods don’t work. It’s best to have surgery before your child starts walking.

About the Ponseti method

The Ponseti technique uses a series of casts and usually fixes clubfott in two to three months.

For this treatment, an orthopedic surgeon gently stretches your baby’s foot toward the correct position and then puts it in a long cast from the toes to the upper thigh. This process is repeated every four to seven days with a new cast until the foot is in the correct position

Before the final cast, the surgeon may make a tiny cut to your baby’s Achilles tendon (heel cord), which connects the heel to the calf muscle. This cut will allow the tendon to grow to a normal length.

After the last cast is removed, you may need to do stretching exercises with your baby. They may also wear special shoes or a foot brace at night and during naps for a few years.

What is the long-term outlook for babies with clubfoot?

With early diagnosis and treatment, almost all babies with clubfoot grow up to have normal feet. They can run, take part in sports and wear regular shoes.

If only one foot is affected, you may notice your child’s foot is smaller than the other. The calf muscle in the affected leg may also be smaller. 

While treatment is very successful, clubfoot does not get better on its own. If left untreated, your baby may have:

• Walking problems – a child with untreated clubfoot may walk on the sides and tops of the feet
• Foot problems (like calluses) and infections
• Arthritis – a condition that causes joint pain, aches, stiffness and swelling

How we care for clubfoot at Banner Children’s

If you think your child has clubfoot, contact Banner Children’s. Our pediatric orthopedic specialists offer your child complete care to cover all of their needs. We will explain all treatment options to help you choose what’s best for your child.