What is Clubfoot ?

Clubfoot is the common name of a deformity of the foot and ankle, present at birth. The medical term for clubfoot is Congenital Talipes Equinvarus. Clubfoot may affect either one foot or both.

How common is clubfoot?
Clubfoot is estimated to affect about 5000 babies born in the United States alone. That is about 1 in 735 children born each year. Statistics also show the high incidence of severe clubfoot in boys more than girls. However, mild clubfoot is found to be equally common in both boys and girls alike.

What are the symptoms of clubfoot?
The common symptoms of clubfoot are:
• Heel turned in or twisted.
• Foot (fore foot or mid foot) turned in.
• Foot bones, ankle joints, muscles and ligaments of the foot may look abnormal.
• Unable to place foot on the ground in a standing position.

What are the causes of clubfoot?
Clubfoot is a congenital defect, that is, it is a problem seen at birth. Researchers are unable to arrive at the exact reasons for clubfoot. The most common causes of clubfoot are genetic factors. It is observed that in most cases it stems from the abnormalities in the fetus during the first trimester (8 to 12) weeks of pregnancy. The abnormal development of the muscles, tendons and bones during this period may lead to clubfoot. In almost 50% of the cases, it is seen in both feet. It is also noticed that normal parents with an affected child run a risk of 2-5% in the case of the next child being born with clubfoot.

Clubfoot is also associated with some neurogenic conditions like cerebral palsy, tethered cord, arthrogryposis and connective tissue disorders like Larsen’s syndrome, diastrophic dwarfism and mechanical conditions like congenital constriction bands. In these cases, the clubfoot seen is severe and requires surgical correction.
 

How is clubfoot diagnosed?
Clubfoot is diagnosed during the examination of the newborn. These days with advanced technology it is possible to detect it during the 16-week prenatal scanning. Early detection helps in deciding on the best treatment options, although the disorder cannot be treated before the birth of the child. Sometimes doctors insist on X-ray examination of the foot to detect any abnormality in the shape of the foot. This helps to ascertain the exact nature of the defect of the foot, especially in cases where the disorder maybe simply because of the abnormal position of the child in the uterus.

Treatment of clubfoot
Clubfoot should be treated at the right time to avoid complications later. It might lead to a chronic disability due to the wrong style of walking that the affected person is likely to develop.

The common treatment options available are
Strapping and physiotherapy: This is common and beneficial in cases which are mild. In this method, adhesive strapping is wound round the affected leg to hold it in the right position. It should be changed weekly, ideally with the help of a physiotherapist. However, it is helpful only till about the child is three months, after which the child may start kicking out the straps.

Plaster fixation: In this method, the doctor hold the foot in place in plaster. The plaster can stay for about 4 weeks.

Splinting: Different kinds of splints are available, the most common being the Ankle Foot Orthosis. The child may wear these splints through the day or only at night on the advice of your child’s physician.

Ponseti method: This is perhaps the most popular treatment for clubfoot. In this method, a regular cast is worn followed by the wearing of a splint. The splint is normally worn at night. This is a long treatment involving two to four years. However, parents seem to prefer this as it avoids surgery.

The Ponseti method of treatment should start after birth. It consists of plaster casting of the foot with gentle manipulations of the ligaments and tendons of the foot every week. Through this the right alignment of the bones are achieved. Along with Ponseti’s method of treatment, a heel cord lengthening is also done, by cutting the heel cord (Achilles tendon), lengthening through a tenotomy and then the foot is placed in a plaster cast for about three weeks. After the cast is removed, the child is given a special orthopedic device called Denis Browne bar which is fit shoulder width apart and is worn with special shoes.

How can clubfoot be prevented?
It is difficult to prevent clubfoot through early treatment, even if it is detected early. However a few precautions can be taken to prevent clubfoot. Pregnant women should refrain form smoking as this may adversely affect the child. During pregnancy, mothers with a family history of clubfoot should be cautious. It is good to go for a genetic counseling from your physician. Early detection will also psychology prepare the parents and make them stronger to assist the affected child.

Research and support groups for clubfoot
There are ongoing clinical studies and researches on the genetic and environmental factors that may be responsible for clubfoot. They are also examining the growth of the muscles, nerves and bones of the child in the fetal stage so as to find out the cause and the possible prevention of clubfoot. Support groups started by parents with children who are affected with clubfoot are a source of emotional support. It also affords them a forum to discuss their specific issues. Click on http://www.clubfoot.co.uk/journal.htm to read about one such effort.
 

Article Contributed By: Sabina Zacharias

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