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Clubfoot: Causes, Symptoms, Risk Factors, Diagnosis, Treatment And Prevention

Clubfoot is a congenital foot abnormality in which the newborns' foot is twisted sidewards towards the opposite leg. According to the National Institutes of Health, one in every 1000 infants is born with clubfoot, which causes them many physical problems at a later stage of life if not treated early. [1]

This foot defect occurs either in one leg or both legs of the newborn. It isn't painful for babies but may cause them difficulty in walking as they grow older. Clubfoot occurs in newborns when their tendons (connecting tissues) between the legs and the heel get shorter than usual causing the foot to twist inwards.

Causes Of Clubfoot

The exact cause for clubfoot is still unknown. However, certain theories indicate that the main cause of clubfoot is due to some defective genes along with environmental factors. Though some genetic factors are majorly believed to cause this defect, the lack of research in the field denies the exact gene responsible for it. Also, clubfoot can occur to a newborn who does not have a family history of any such conditions.[2]

The cause of clubfoot is also linked to some skeletal disorders like spina bifida and hip dysplasia in which the spinal cord fails to develop since birth. However, it is to be noted that the condition is not caused by the position of the foetus in the uterus.

Symptoms Of Clubfoot

The symptoms of clubfoot can be mild or severe. Appearance-wise, the symptoms of clubfoot are as follows: [3]

  • Foot and legs are shorter than normal.
  • Foot turned inward and down with a deep crease at the bottom.
  • Underdeveloped calf muscles
  • If clubfoot is in one leg, that side of the leg will be slightly shorter.
  • The heel will be slightly smaller than normal.

Risk Factors Of Clubfoot

Compared to females, males are twice as likely to be born with clubfoot. Other risk factors of clubfoot are as follows:

  • Neuromuscular disorders: Congenital conditions like cerebral palsy (CP) and spina bifida may increase the risk of clubfoot in newborns. [4]
  • Family history: Though the condition is not genetic, it is likely to occur in newborns who have a family history of the condition. [5]
  • Environment: Factors like maternal smoking during pregnancy may increase the risk of this defect. [6]
  • Oligohydramnios: It is a condition identified by the decrease in amniotic fluid during pregnancy. [7]

Complications Of Clubfoot

Clubfoot does not cause any health problems to newborns until they start to walk. That's why the condition is operated at an early stage before the infant starts movements. However, if the condition remains untreated, it may cause the following complications: [8]

  • Arthritis
  • Unusual body appearance
  • Inability to walk on the foot
  • Affected calf muscles

Diagnosis Of Clubfoot

Clubfoot can be identified soon after birth by visualizing the irregular shape of the newborn's foot. However, it can also be detected by the ultrasound during the pregnancy routine checkup in around 24 weeks. Once the baby is born, the pediatric orthopaedic surgeon may request X-rays or CT scan to know the seriousness of the condition and proceed accordingly. Also, a genetics counsellor is assigned to understand the family history of the newborn. [9]

Treatment Of Clubfoot

The treatment of clubfoot involves both surgical and non-surgical methods which are as follows: [10]

  • Ponseti method: In this nonsurgical method, the legs of the newborns are gently stretched to the corrected position and held in that position with the help of long-leg plaster which is repeated every week. Then a minor surgical procedure is followed in which the tendons are cut and again a new plaster is applied. This is carried out so that the tendons can regrow in a correct form. As the clubfoot have the tendency to grow back, to ensure the permanent stay of the foot in the correct position, the babies are made to wear a brace for a few years.
  • French method: This nonsurgical treatment is carried out by the physical therapist. In the method, the baby's foot is stretched, exercised and massaged daily accompanied by taping it with a plastic splint to maintain its correct position. The process is trained to parents as it is a daily process and should be repeated until the child reaches two years of age.
  • Surgery: This method is applied only when nonsurgical treatments do not respond. In this method, the orthopaedic surgeon operates the tendons and ligaments to the correct position and later, the leg of the child is plastered for up to two months followed by foot bracing for a year to prevent the condition from occurring.

Prevention Of Clubfoot

As the exact cause of clubfoot in newborns are still unknown to the medical experts, people can take preventive measures such as:

  • Smoking during pregnancy
  • Avoiding alcohol abuse during pregnancy
  • Avoiding unprescribed medications during pregnancy
View Article References
  1. [1] Parker, S. E., Mai, C. T., Strickland, M. J., Olney, R. S., Rickard, R., Marengo, L., ... & Meyer, R. E. (2009). Multistate study of the epidemiology of clubfoot. Birth Defects Research Part A: Clinical and Molecular Teratology, 85(11), 897-904.
  2. [2] Dobbs, M. B., & Gurnett, C. A. (2009). Update on clubfoot: etiology and treatment. Clinical orthopaedics and related research, 467(5), 1146–1153. doi:10.1007/s11999-009-0734-9
  3. [3] Brodsky, J. W. (2010). The adult sequelae of treated congenital clubfoot. Foot and ankle clinics, 15(2), 287-296.
  4. [4] Swaroop, V. T., & Dias, L. (2011). Orthopaedic management of spina bifida-part II: foot and ankle deformities. Journal of children's orthopaedics, 5(6), 403–414. doi:10.1007/s11832-011-0368-9
  5. [5] Dobbs, M. B., & Gurnett, C. A. (2012). Genetics of clubfoot. Journal of pediatric orthopedics. Part B, 21(1), 7–9. doi:10.1097/BPB.0b013e328349927c
  6. [6] Pavone, V., Chisari, E., Vescio, A., Lucenti, L., Sessa, G., & Testa, G. (2018). The etiology of idiopathic congenital talipes equinovarus: a systematic review. Journal of orthopaedic surgery and research, 13(1), 206. doi:10.1186/s13018-018-0913-z
  7. [7] Christianson, C., Huff, D., & McPherson, E. (1999). Limb deformations in oligohydramnios sequence: effects of gestational age and duration of oligohydramnios. American journal of medical genetics, 86(5), 430-433.
  8. [8] Chotigavanichaya, C., Eamsobhana, P., Ariyawatkul, T., Saelim, C., & Kaewpornsawan, K. (2016). Complications associated with PonsetI serial casting and surgical correction via soft tissue release in congenital idiopathic clubfoot. J Med Assoc Thai, 99(11), 1192-7.
  9. [9] Besselaar, A. T., Sakkers, R., Schuppers, H. A., Witbreuk, M., Zeegers, E., Visser, J. D., … Burger, K. (2017). Guideline on the diagnosis and treatment of primary idiopathic clubfoot. Acta orthopaedica, 88(3), 305–309. doi:10.1080/17453674.2017.1294416
  10. [10] Anand, A., & Sala, D. A. (2008). Clubfoot: etiology and treatment. Indian journal of orthopaedics, 42(1), 22–28. doi:10.4103/0019-5413.38576
Story first published: Tuesday, January 7, 2020, 13:02 [IST]