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Clubfoot

What is clubfoot?

Clubfoot, also known as talipes equinovarus, is a congenital (present at birth) foot deformity. It affects the bones, muscles, tendons, and blood vessels and can affect one or both feet. The foot is usually short and broad in appearance and the heel points downward while the front half of the foot (forefoot) turns inward. The heel cord (Achilles tendon) is tight. The heel can appear narrow and the muscles in the calf are smaller compared to a normal lower leg.

It occurs in about one in every 1,000 live births and affects boys twice as often as girls. About half of clubfoot cases affect both feet.

What causes clubfoot?

Clubfoot is considered a "multifactorial trait." Multifactorial inheritance means there are many factors involved in causing a birth defect. The factors are usually both genetic and environmental.

Often one gender (either male or female) is affected more frequently than the other in multifactorial traits. There appears to be a different "threshold of expression," which means that one gender is more likely to show the problem than the other gender. For example, clubfoot is twice as common in males as it is in females. Once a baby has been born with clubfoot, the chance for it to happen again in a male or female child is about 4 percent overall. In other words, there is a 96 percent chance that another baby would not be born with clubfoot.

What are the risk factors for clubfoot?

Risk factors may include the following:

Babies born with clubfoot may also be at increased risk of having an associated hip condition, known as developmental dysplasia of the hip (DDH). DDH is a condition of the hip joint in which the top of the thigh bone (femur) slips in and out of its socket because the socket is too shallow to keep the joint intact.

How is clubfoot diagnosed?

Your baby's physician makes the diagnosis of clubfoot at birth with a physical examination. During the examination, your baby's physician obtains a complete prenatal and birth history of the baby and asks if other family members are known to have clubfoot. If the diagnosis of clubfoot is made in an older infant or child, the physician will also ask about developmental milestones since clubfoot can be associated with other neuromuscular disorders. Developmental delays may require further medical follow up to evaluate for underlying problems.

Diagnostic procedures of the foot may include:

The affected foot may be flexible, known as a "positional clubfoot." This flexible type of clubfoot is caused by the baby's position in the uterus. Positional clubfoot can easily be positioned into a neutral (not curved) position by hand. A true clubfoot is stiff, or rigid, and very hard to manipulate.

The symptoms of clubfoot may resemble other medical conditions of the foot. Always consult your baby's physician for a diagnosis.

Treatment for clubfoot

Non-surgical treatment

Our philosophy is to correct the deformity and stiffness as early as possible to minimize secondary changes such as talar (anklebone) flattening. Serial casting often will help correct the deformity in newborns. If the child fails to achieve this goal, orthopaedic surgeons at The Children's Hospital of Philadelphia then can surgically correct the remaining deformities.

Cast care instructions
When to call your baby's physician

Contact your physician if your baby develops one or more of the following symptoms:

Surgical treatment

Surgical correction can begin on your child when casting no longer improves the condition, often as early as 3 months of age. Surgery may include:

If the deformities occur in both of the child's feet, we often can correct them safely during a single procedure.

Surgery is performed in our fully equipped surgical suites and is supported by a team of anesthesiologists experienced in managing the infant and child.

After surgery, our casting team may create a custom-made cast or brace for your child. The brace, called a thermoplastic brace, will allow room for your child's foot to grow and will help achieve an optimal result.

Long-term outlook for a baby with clubfoot:

Most babies with clubfoot can be corrected with serial manipulation and casting. Some babies may require surgery to help correct the position of the foot. Additional surgeries may be necessary since the deformity may come back as the child grows and develops.

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