Congenital clubfoot, or talipes equinovarus, is a complex deformity that is readily apparent at birth and affects the muscles, ligaments, bones and joints of the developing foot and ankle. The ankle is rotated downward and the toes point inward towards the opposite leg. All foot bones are usually present, but are out of normal alignment. All of the foot and leg muscles are also present, but some are smaller and weaker than normal. Tendons and ligaments are contracted, especially behind the ankle and along the instep.
Why my baby?
Many parents ask this question. It helps to understand that clubfoot is among the most common of birth defects.
Worldwide, more than one baby in a thousand is born with this foot deformity. That may not sound like a lot, but it is:
every year more than 100,000 babies worldwide are born with a clubfoot or clubfeet. Fifty percent of cases affect one
foot, and fifty percent affect both feet. Boys are more commonly affected than girls. Sometimes clubfoot runs in families. It also helps to understand that clubfoot responds well to treatment. When treated by medical experts, children born with clubfeet and no other significant medical problems will have feet that are capable of a normal, active life.
What causes clubfoot?
There are many theories, however the actual cause is not known. There is no need for parents to feel at fault.
Does this mean my baby has other problems?
Your doctor will check your baby thoroughly directly after birth. Most often, clubfoot is an isolated condition from
an unknown cause (idiopathic clubfoot). Rarely, there are other conditions that are also noted such as spina bifida
(syndromic clubfoot). Occasionally the foot may have been held in a curved position in a crowded uterus (positional clubfoot); for example, if there are twins. Positional clubfoot is much quicker to correct than idiopathic or syndromic clubfoot. Your doctor will tell you what type of clubfoot your baby has.
When should treatment begin?
Babies suspected of having clubfoot at the newborn exam are usually referred right away to the orthopaedic team or
clubfoot clinic. Infants are seen within a few days and treatment begins.
How severe is my baby’s clubfoot?
All clubfeet are not of the same severity, although all have the same general appearance. Some doctors measure or
score the amount of deformity present (see chart page 29). Scoring can assist the doctor to determine the severity
of the clubfoot and to measure the progress of correction.
Understanding Clubfoot
Clubfoot treatment using the Ponseti Method can be considered in three phases:
What is relapse and how is it treated?
Clubfeet have a stubborn tendency to relapse, or come back, after casting correction. Relapses are treated the same way, through manipulation and casts, although casts are applied less frequently and typically correct within fewer castings. Rarely a clubfoot may be resistant. In such a case, your orthopaedic surgeon may recommend surgery, such as a tendon transfer, which would be explained by your surgeon at that time. This booklet addresses non-surgical correction.
What happens if clubfoot is not treated?
Left untreated, the deformity persists and results in severe physical – and emotional – handicap.
Will this process be painful for my baby?
There may be some discomfort for your baby as he or she adjusts to the treatment, but the process is likely to be more painful for you as a caring parent than it is for your baby. This site explains the process and your important role in it to make correction easiest on both of you.
How will my child do as a grown-up?
Children with clubfeet corrected by the Ponseti Method grow up to have feet that are almost normal in shape and function. For children with one clubfoot, the corrected foot and calf may be slightly smaller. Children with corrected clubfeet grow normally and are able to participate in most sports or leisure activities. Studies in adults show that patients treated using the Ponseti Method continue to have as strong and as healthy feet as adults born with normal feet.
Why my baby?
Many parents ask this question. It helps to understand that clubfoot is among the most common of birth defects.
Worldwide, more than one baby in a thousand is born with this foot deformity. That may not sound like a lot, but it is:
every year more than 100,000 babies worldwide are born with a clubfoot or clubfeet. Fifty percent of cases affect one
foot, and fifty percent affect both feet. Boys are more commonly affected than girls. Sometimes clubfoot runs in families. It also helps to understand that clubfoot responds well to treatment. When treated by medical experts, children born with clubfeet and no other significant medical problems will have feet that are capable of a normal, active life.
What causes clubfoot?
There are many theories, however the actual cause is not known. There is no need for parents to feel at fault.
Does this mean my baby has other problems?
Your doctor will check your baby thoroughly directly after birth. Most often, clubfoot is an isolated condition from
an unknown cause (idiopathic clubfoot). Rarely, there are other conditions that are also noted such as spina bifida
(syndromic clubfoot). Occasionally the foot may have been held in a curved position in a crowded uterus (positional clubfoot); for example, if there are twins. Positional clubfoot is much quicker to correct than idiopathic or syndromic clubfoot. Your doctor will tell you what type of clubfoot your baby has.
When should treatment begin?
Babies suspected of having clubfoot at the newborn exam are usually referred right away to the orthopaedic team or
clubfoot clinic. Infants are seen within a few days and treatment begins.
How severe is my baby’s clubfoot?
All clubfeet are not of the same severity, although all have the same general appearance. Some doctors measure or
score the amount of deformity present (see chart page 29). Scoring can assist the doctor to determine the severity
of the clubfoot and to measure the progress of correction.
Understanding Clubfoot
Clubfoot treatment using the Ponseti Method can be considered in three phases:
- Correction. The Ponseti method uses very specific and gentle manipulations to align the foot in a more normal position, and casting to allow the soft bones to “set”. Usually, about five weekly casts and a minor procedure to the Achilles tendon (tenotomy) are all that is needed to achieve full correction. Difficult clubfeet sometimes need more casts.
- Prevention of Relapse. After correction, a brace is then necessary to prevent relapse. The brace is worn full time for two to three months, and then during nighttime and naps until the child reaches at least four years of age.
- Surveillance. Your child will have regular visits until fully grown to monitor how the legs and feet are growing. Keep in mind that all children are different and length of treatment may vary.
What is relapse and how is it treated?
Clubfeet have a stubborn tendency to relapse, or come back, after casting correction. Relapses are treated the same way, through manipulation and casts, although casts are applied less frequently and typically correct within fewer castings. Rarely a clubfoot may be resistant. In such a case, your orthopaedic surgeon may recommend surgery, such as a tendon transfer, which would be explained by your surgeon at that time. This booklet addresses non-surgical correction.
What happens if clubfoot is not treated?
Left untreated, the deformity persists and results in severe physical – and emotional – handicap.
Will this process be painful for my baby?
There may be some discomfort for your baby as he or she adjusts to the treatment, but the process is likely to be more painful for you as a caring parent than it is for your baby. This site explains the process and your important role in it to make correction easiest on both of you.
How will my child do as a grown-up?
Children with clubfeet corrected by the Ponseti Method grow up to have feet that are almost normal in shape and function. For children with one clubfoot, the corrected foot and calf may be slightly smaller. Children with corrected clubfeet grow normally and are able to participate in most sports or leisure activities. Studies in adults show that patients treated using the Ponseti Method continue to have as strong and as healthy feet as adults born with normal feet.