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Clubfoot resembles the head of a golf club, and is usually diagnosed immediately after birth.

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Clubfoot is a common foot deformity among infants; it is usually identified right after birth. The term “clubfoot” refers to the way the foot is positioned at a sharp angle to the leg, resembling the head of a golf club, and can be due to a range of abnormalities.

Your baby’s pediatrician will likely diagnose clubfoot in the newborn nursery. The foot will be rigid, meaning it cannot be moved to an anatomically correct position. The calf muscle may be underdeveloped, and the bones of the lower leg and foot may not be developed appropriately.

Diagnosis

There are two different types of clubfoot: congenital and teratologic.

  • Congenital—In this type, clubfoot is usually an isolated finding, meaning there are no other abnormal physical findings. Approximately 75 percent of all cases of clubfoot are congenital. Sometimes, a normal foot that has been compressed into an abnormal position before birth may appear to be a clubfoot. However, in this case, the foot is not fixed in place and is flexible enough to be moved back into a correct position.
  • Teratologic—This type of clubfoot is associated with a neurologic disorder, and the infant will usually have other abnormalities on physical exam as well.

The cause of clubfoot is unknown. It occurs in approximately 1 out of 1000 infants. Clubfoot is more common in male infants and affects both feet 50 percent of the time. It tends to run in families, especially if one parent suffered from the condition as an infant. Risk factors also include smoking, illicit drugs, low amniotic fluid, or infection during pregnancy. Sometimes, clubfoot can be diagnosed in utero by routine ultrasound examination.

Your child’s pediatrician may order x-rays to assess the foot, then will likely refer your child to an orthopedic doctor for further evaluation.

Treatment 

Treatment is usually conservative at first, but some infants will eventually require surgery. The goal of the conservative treatment is to improve the positioning and flexibility of the foot before your baby learns to walk. The most common treatment, called the Ponseti method, is to move the baby’s foot toward a correct anatomical position, then apply a cast to hold it in place. The cast is replaced every week or so, allowing your baby’s foot to be repositioned each time. Therapy also includes daily stretching exercises as well as special shoes and leg braces after the casts are removed. Some infants will need a minor surgical procedure to lengthen the Achilles tendon toward the end of the process. If this is not successful, a more invasive surgery may be required.

Even after treatment, clubfoot is not always completely correctable. However, most children grow up to wear regular shoes and are able to lead active lives in spite of the difficult start.

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References

  1. Journal of the American Academy of Orthopedic Surgeons. Bracing following correction of idiopathic clubfoot using the Ponseti Method.
  2. Mayo Clinic. Clubfoot.
  3. Nelson Textbook of Pediatrics, 19th edition.

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