Clubfoot

Clubfoot : It is a congenital deformity, i.e. present at birth. It affects the foot and/or ankle. In patients with clubfoot, the bones, joints, blood vessels, and muscles in the foot are formed incorrectly. This results in either mild or severe deformities. Most notable is the `kidney shape' of the foot. It can affect one or both feet, more frequently the left. In about half of the cases, both feet are affected.

• What is clubfoot?
• What is the cause?
• What are the symptoms?
• What is the diagnosis?
• What is the treatment?

What is clubfoot?

Clubfoot is a congenital deformity, i.e. present at birth. It affects the foot and/or ankle. In patients with clubfoot, the bones, joints, blood vessels, and muscles in the foot are formed incorrectly. This results in either mild or severe deformities. Most notable is the `kidney shape' of the foot. It can affect one or both feet, more frequently the left. In about half of the cases, both feet are affected.

Clubfoot can occur by itself or it can be accompanied by other birth defects such as malformation syndromes or chromosomal syndromes.

There are three types of clubfoot:

1. Calcaneal Valgus
There is an angling of the foot at the heel. When this occurs, the top of the foot looks as if it is bent to the side and the toes point up and out.

2. Matatarusus Varus
In this the front of the foot is turned inwards.

3. Talipes Equinovarus
Here the foot is turned inwards and down.

In clubfoot, each child is likely to have some of each of the following:

Plantar flexion: this refers to the twisting of the ankle which causes the heel to be drawn up.

Cavus foot deformity: this refers to the high arch of the foot. In some cases a high arch is very noticeable. In other cases, because of the angling of the foot, the height may be difficult to determine. In these cases, a crosswise crease on the sole of the foot may be a good indication.

Varus: this refers to the inversion of the heel which causes the front of the foot to turn inward

Adduction of the forefoot: this refers to amount the forefoot is pulled downward

What is the cause?

 There is no one known cause for clubfoot. It may happen in the womb due to cramping or twisting, somewhere around the 10th-12th weeks of pregnancy. Some believe that heredity or other factors known to cause birth defects may be to blame. These include use of drugs or alcohol, or experiencing certain diseases.

There are some diseases such as myelomeningocele and constriction band syndrome that may lead to clubfoot. Twice as many boys as girls have clubfoot and heredity may be a factor. If one child has it, there is a 3% to 4% chance a sibling may have it too. And, if one parent and one child have it, the odds increase to a 25% chance of a second child having it.

What are the symptoms?

•   Noticeable deformity in the foot
•  Stiffness in the ankle or in foot tendons
•  The calf appears shorter than the other leg (in cases where only one foot is affected)
•  Foot or feet turned or twisted awkwardly
•  Affected foot lacks the normal range of motion

What is the diagnosis?

 The disorder is identified during a physical examination. A foot X-ray may be performed.

What is the treatment?

 It is important to treat clubfoot as soon as it is diagnosed to avoid later problems. With proper and professional treatment, clubfoot does not represent a long-term disability or handicap. In many cases, it can be corrected within about six to eight weeks by exercise, manipulation and stretching of the heel cord, and casting.

Chances of correction are optimal during the first two weeks of life, when the tissues and ligaments are very elastic-like and pliable. The treatment should begin as early as possible - ideally, just after birth when the foot is easiest to reshape.

In more severe cases of clubfoot, surgery may be required to lengthen the heel cord. The forefoot correction and hind foot correction take more time and the heel cord lengthening can be left until the child is older. Surgery can be accompanied by scarring, stiffness and muscle weakness that can become disabling in later years.

If passive treatment of the condition, such as using stretching or casting or both, is used, it is important to have the foot evaluated periodically. There is a tendency for clubfoot to relapse because of growth. This is true particularly in the first two or three years of life, although it is possible it may happen even up to age 7.

Splints are used after the last cast comes off to help prevent the clubfoot from reappearing. The splints must be worn full-time for several months, and then nightly for the following two to four years.