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What is Clubfoot?
Causes
Risk Factors
Different types of Clubfoot
Symptoms
Diagnosis
Complications
Treatment
What are the chances of a full recovery?

Discovering that your baby has clubfoot at birth can be a distressing experience for parents. While it won’t get better on its own, when clubfoot is effectively managed, your child will have fairly normal foot health and be able to wear normal shoes, and walk, run and play as expected.

What Is Clubfoot?

A ‘clubfoot’ describes a position where the foot starkly twists inwards (so that the sole of the foot is facing the other foot) instead of being straight. This means that it affects the tendons and bones of the feet, as well as the calf muscles. Clubfoot is present straight from birth and is relatively common, affecting approximately 1 in every 1000 newborns. One or both feet can be affected.

What Causes Clubfoot?

Clubfoot is still largely considered idiopathic, meaning no one definitely knows why some babies are born with a clubfoot and others aren’t. Genetics are thought to play a role, as well as the environment - such as having limited space inside the womb or simply the position the foot naturally falls into. Clubfoot typically occurs in isolation - meaning that babies with clubfoot are not linked with having other medical conditions.

There are two other types of clubfoot where the clubfoot is a symptom of an underlying condition. Neurogenic clubfoot is linked to having an underlying neurological condition, such as spina bifida or cerebral palsy. There’s also syndromic clubfoot, where there’s an underlying syndrome, such as arthrogryposis (characterised by joint stiffness and contractures), that results in the clubfoot. In both of these cases, there are usually many more symptoms than just the clubfoot, so the underlying conditions are detected early (at birth or in the womb) and managed by pediatricians upon delivery.

What Risk Factors Make People More Susceptible To Clubfoot?

Clubfoot is seen more in boys than girls, and it often has a tendency to affect more than one family member. Having low levels of amniotic fluid during pregnancy can also increase the likelihood of clubfoot, and a strong link between smoking and clubfoot has been found in the research. In fact, the combination of a family history of clubfoot paired with smoking increases the risk for clubfoot twenty-fold.

What Are The Different Types Of Clubfoot?

• Isolated Clubfoot

An isolated clubfoot is the name for the clubfoot we’ve been describing so far, where the cause is generally undetermined and the condition is present at birth. The term ‘isolated’ is used because it is not associated with other medical conditions or problems, instead it occurs as an isolated event.

• Complex Clubfoot

A complex clubfoot is one that develops from incorrect, failed or poor treatment of an initial clubfoot, regardless of the cause of the clubfoot. Poor plaster casting techniques, having the cast frequently slip down, or casting a swollen leg are all factors that can lead to a complex clubfoot. This makes the clubfoot more difficult to treat, and children often face skin problems beneath the cast, such as redness and abrasions and bruising.

• Recurrent Clubfoot

A recurrent clubfoot is one in which the appearance of the clubfoot (and all the symptoms) return after it is successfully treated. If treatment (particularly bracing) is stopped early, this may lead to clubfoot recurrence, although it can also happen anytime until the bones of the feet and legs are mature.

What Are The Symptoms Of Clubfoot?

Don’t worry, a clubfoot isn’t painful for your baby, and it won’t even cause them any issues until it’s time for them to stand and walk. With a clubfoot, the main symptom is that the foot is starkly angled inwards so that the sole of the foot is facing the midline of the body, which can make the clubfoot appear like it's shorter than the other foot. While the calf muscles may be undeveloped in the clubfoot, this may or may not be very obvious at first with the appearance of a thinner calf. There may also be a crease on the bottom of the foot.

How Can You Diagnose Clubfoot?

Many cases of clubfoot are actually diagnosed via ultrasound during pregnancy, often at the 20-week anatomy scan. Otherwise, clubfoot is typically detected at birth. It is very rare to see an undiagnosed case of clubfoot due to the screenings that newborns have at the hospital by pediatricians and midwives. Diagnosing a clubfoot is very easy due to the notable foot features, so only requires a visual and quick physical exam. 

The Importance Of Early Detection

Early detection is crucial for clubfoot because it allows for timely and effective treatment, which can significantly improve the long-term outcomes and quality of life for those with clubfoot. Early treatment means improved treatment success in a shorter timeframe, as the bones, joints, and soft tissues are still growing and more adaptable in infancy. Early care may also reduce the likelihood of complications as well as the need for extensive surgical interventions, while overall supporting optimal foot and leg function both in childhood and into adulthood. This means that early care may also help prevent or minimise any long-term disability and the associated physical and psychological challenges that untreated or late-treated clubfoot may otherwise pose.

What Complications Can Clubfoot Cause?

If left untreated or if treatment is not successful, clubfoot can lead to several complications, both in terms of foot function and the overall development and well-being of the affected individual. Complications may include:

• Abnormal gait (walking pattern) which can lead to pain and difficulty in walking, running, or participating in physical activities.
  

• Foot and leg deformities including a twisted foot, rigid equinus (the inability to point the foot upward), and limited range of motion in the affected joints.
  

• Pain and discomfort
  

• Skin problems such as calluses, blisters, and pressure sores, which can be painful and challenging to manage.
  

• The joints in the affected foot may become stiff due to the improper positioning and limited range of motion, which can lead to reduced mobility and function
  

What Are The Treatment Options For Club Foot?

The main treatment for clubfoot is completed with your paediatrician or care team and typically involves stretching and casting techniques known as the Ponseti method. This is where a series of casts are used to hold your baby's foot in a corrected position, typically involving 4-6 casts depending on the severity of the clubfoot. Casting stops when the foot is ready for its next stage of correction, where a very small surgical procedure is completed (often just under local anaesthetic in the clinic) to help lengthen the Achilles tendon. A new cast is then applied that stays on for a few weeks while the tendon heals with the foot in an optimal position. Following this, there’s a fair amount of stretching exercises needed to help maintain and support the foot position, as well as specific shoes and braces that may be required for a few more years. These allow the foot to stay in a  good position while your child grows and stays active. Following this, at approximately age four, your child will have close monitoring to check their progress, determine if further treatment is needed, and help prevent the foot from turning into the clubfoot position.

From a podiatry perspective, we support both children and adults throughout their clubfoot treatment and long after treatment has finished in a range of ways. In the early years, the position of the foot may lead to other aches and pains, as well as skin changes like corns and calluses. If clubfoot is present on only one foot that is cast, it is not uncommon for the other foot to become overloaded and sore if the child is mobile. For those that move into adolescence and adulthood after having their clubfoot treated, podiatrists help with any residual gait abnormalities or areas of high pressure, as well as any injuries that occur as a result of overloading the feet. We use:

• Custom footwear or footwear modifications to help support optimal gait and comfort on the feet
  
• Child-friendly ankle-foot orthotics (AFOs), including our innovative Surestep brace 
  
• Foot orthotics to help with any pains or address inefficiencies in foot function. The prescription here typically differs substantially between the two feet, which is why it’s always important to have your orthotics professionally prescribed by an experienced podiatrist if you have a history of clubfoot.
  
• Foot mobilisation, dry needling and other techniques to help with tightness or weakness in the feet, whether that is linked to a previous clubfoot or not
  
• Shockwave treatment if tendon damage or strain is present to accelerate healing and repair
  
• MLS laser for pain relief and accelerated recovery
  
• Skin and nail care for any changes or problems related to the foot position or function 
  
• Stretching and strengthening programs to best support your lower limb health and function
  

A large part of thriving and maintaining good foot function after clubfoot treatment is being aware of how to best care for your feet, avoid complications, and reduce the chance of your treatment progress going backwards. This is also an area that your podiatrist can help by both educating you on everything you need to know, as well as helping put the right preventative measures in place. 

Why Is It Important To Get A Personalised Treatment Plan?

As a clubfoot can range in severity from mild to severe, and treatment progresses at different rates and with variable results, you must always get a personalised treatment plan to ensure that the right steps and approach is being taken for your child’s feet and their unique circumstances. Both your paediatrician and your podiatrist will make a range of unique care decisions based on your child’s personal progress and the characteristics of their feet. Even elements like knowing how a foot is responding to treatment influences how the treatment progresses.

What Are The Chances Of Full Recovery From Clubfoot?

As long as your child gets the right treatment early, the chances of full recovery from clubfoot are quite high, with many clubfoot patients achieving 100% recovery that allows them to walk normally, wear normal shoes, and participate in sports.

Final Thoughts On Club Foot

It can be hard to know what we can be doing to best support children born with clubfoot. To help your child get the best long-term results, prioritise starting treatment early, attend all follow-up appointments to monitor progress, and  consistently help your child perform their stretches and continue any prescribed rehab to best support their foot health. All in all, clubfoot serves as an excellent example of how medical advances and proactive care can transform an initially challenging congenital condition into a manageable and often fully corrected condition, enabling affected individuals to enjoy a fulfilling and unrestricted future.