Clubfoot

Clubfoot, also known as congenital talipes equinovarus (CTEV), is a deformity of the foot present from birth. It results from abnormal development of the muscles, tendons and bones in the foot while a fetus is forming during pregnancy. This happens in about 150,000-200,000 babies worldwide each year. While researchers have not been able to find the exact cause of clubfoot, both genetic and environmental factors may play a role. Clubfoot is about twice as common in boys, and occurs in both feet about 50 percent of the time.

A clubfoot consists of four major features:

  1. Cavus of the midfoot: there is a very high arch to the foot
  2. Adductus of the forefoot: the front part of the foot is turned in
  3. Varus of the hindfoot: the heel is turned in
  4. Equinus of the hindfoot: the entire foot is pointing down

A clubfoot is often an isolated finding, meaning your child will otherwise be healthy. In fact, there are many famous athletes who were born with clubfeet, including Troy Aikman (NFL football) and Kristi Yamaguchi (Professional and Olympic Figure Skater). There are some cases, however, when clubfeet can be associated with other medical conditions, such as arthrogryposis or spina bifida. These types of medical conditions are often diagnosed before your child is born.

Treatment

Without treatment, a child will likely have pain, and experience trouble walking and wearing shoes. The best time to start treatment for clubfoot is soon after birth, but treatment can be effective in older children as well. The gold standard for treatment is the Ponseti Method.

Ponseti Method

Our surgeons treat clubfoot in accordance with the Ponseti Method. This method of treatment is minimally invasive and about 95 percent effective. The Ponseti Method is now considered the “gold standard” of clubfoot treatment.

The major principle behind the Ponseti Method is the idea that the tissues of a newborn's foot, including tendons, ligaments, joint capsules and bones, will respond to gentle manipulation followed by casting of the feet at weekly intervals. By applying this Ponseti Method to the clubfoot within the first few weeks of life, most can be successfully corrected without the need for major reconstructive surgery.

  • Corrective Phase: The feet undergo weekly gentle stretching followed by long leg casting with the knee at 90 degrees. The child's normal movements while in the cast allow for further stretching in subsequent visits. Up to 15 percent of clubfeet will be fully corrected using this method alone. Others may require an Achilles tendon release, which stops the foot from pointing downward, for a full correction. Following the Achilles tendon surgery, your child will be placed back in a cast for three weeks to allow the tendon to heal.
  • Maintenance Phase: Following full correction, your child will be required to wear a foot abduction bar and shoes brace to maintain the correction and prevent recurrence. We often prescribe Mitchell shoes. Initially, most children will wear this brace nearly full time (23 hours per day) for the first three months. Following this period, your child will then wear the brace during nap time and at nights until the age of 4. Without wearing these corrective shoes, the risk for recurrence is extremely high, especially in the first two years.

At Children’s, we usually make two exceptions to the classic Ponseti Method. One is that most of our doctors use a semi-rigid fiberglass material for the casting, instead of the plaster of Paris material used by Dr. Ponseti. This material achieves the same results, and it does not require any cutting during removal—which makes removal easier for you and your child. The other exception is that the heel cord clip is performed in the operating room under general anesthesia, rather during an office visit under local anesthesia. We feel this procedure is more safely done in the operating room.

Surgery

For a small percentage of patients, casting may not be effective, and surgery is therefore recommended to achieve correction. Surgical treatment may be extensive and require:

  • Release of soft tissues and joint contractures
  • Tendon lengthening
  • Temporary use of pins to fix the joints in the foot

Prognosis varies based on type and extent of surgery. Your doctor will be able to discuss the details of these surgeries with you if such treatment is recommended.

Prognosis

With early treatment, children with clubfeet can grow up to wear regular shoes, take part in sports and lead full, active lives. If only one foot is involved, the affected foot is generally 1 to 1 1/2 shoe sizes smaller than the unaffected one, the leg is shorter, and the calf appears slightly thinner. These differences do not affect your child’s ability to use their foot or leg normally.