Print-Friendly

Bookmarks

Clubfoot

Talipes equinovarus; Talipes

Clubfoot is a condition that involves both the foot and lower leg in which the foot turns inward and downward. It is a congenital condition, which means it is present at birth.

Causes

Clubfoot is the most common congenital disorder of the legs. It can range from mild and flexible to severe and rigid.

The cause is not known. Most often, it occurs by itself. But the condition may be passed down through families in some cases. Risk factors include a family history of the disorder and being male. Clubfoot can also occur as part of an underlying genetic syndrome, such as trisomy 18.

Trisomy 18

Trisomy 18 is a genetic disorder in which a person has a third copy of material from chromosome 18, instead of the usual 2 copies. Rarely, the extra...

Read Article Now Book Mark Article

A related problem, called positional clubfoot, is not true clubfoot. It results from a normal foot positioned abnormally while the baby is in the womb. This problem is easily corrected after birth.

Symptoms

The physical appearance of the foot may vary. One or both feet may be affected.

The foot turns inward and downward at birth and is difficult to place in the correct position. The calf muscle and foot may be slightly smaller than normal.

Exams and Tests

The disorder is identified during a physical examination.

A foot x-ray may be done. Ultrasound during the first 6 months of pregnancy can also help to identify the disorder.

Treatment

Treatment may involve moving the foot into the correct position and using a cast to keep it there. This is often done by an orthopedic specialist. Treatment should be started as early as possible, ideally, shortly after birth, when it is easiest to reshape the foot.

Gentle stretching and recasting will be done every week to improve the position of the foot. Generally, 5 to 10 casts are needed. The final cast will stay in place for 3 weeks. After the foot is in the correct position, the child will wear a special brace nearly full time for 3 months. Then, the child will wear the brace at night for 3 to 5 years.

Often, the problem is a tightened Achilles tendon, and a simple procedure is needed to release it.

Some severe cases of clubfoot will need surgery if other treatments do not work, or if the problem returns. The child should be monitored by your health care provider until the foot is fully grown.

Surgery

Clubfoot repair is surgery to correct a birth defect of the foot and ankle.

Image

Read Article Now Book Mark Article

Outlook (Prognosis)

The outcome is usually good with treatment.

Possible Complications

Some defects may not be completely fixed. However, treatment can improve the appearance and function of the foot. Treatment may be less successful if the clubfoot is linked to other birth disorders.

When to Contact a Medical Professional

If your child is being treated for clubfoot, contact your provider if:

The toes swell, bleed, or change color under the cast
The cast appears to be causing significant pain
The toes disappear into the cast
The cast slides off
The foot begins to turn in again after treatment

Open References

References

Martin S. Clubfoot (talipes equinovarus). In: Copel JA, D'Alton ME, Feltovich H, et al. Obstetric Imaging: Fetal Diagnosis and Care. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 64.

Warner WC, Beaty JH. Paralytic disorders. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 34.

Winell JJ, Davidson RS. The foot and toes. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 694.

Clubfoot deformity - illustration

Clubfoot is the most common congenital disorder of the lower extremity. One or both feet turn downward and inward. Genetic and environmental factors in the development of the fetus are the apparent causes.

Clubfoot deformity

illustration
Clubfoot repair - series

Presentation

<strong>Clubfoot repair - series</strong><p>The normal position of the human foot is such that the sole of the foot is flat against the ground while walking. Clubfoot is a congenital abnormality in which the foot is adducted (angled inward). Correction of clubfoot is required for normal ambulation later in life.</p>

<strong>Procedure, part 1</strong><p>The newborn baby's deformed foot is initially treated with casts. The tendons, ligaments, and bones are still quite flexible and easier to reposition. The foot is stretched into a more normal position and a light-weight cast is applied to retain the corrected position. The cast will be removed every week or two so the foot can be further stretched into better position and maintained with a new cast. This serial casting is continued for three or more months and is successful in at least 50% of cases. If the casts do not provide enough correction of the clubfoot, surgery is considered.</p>

<strong>Procedure, part 2</strong><p>The type and extent of surgery depends on the how severe the deformity is. The defect involves tight and short tendons around the foot and ankle. The surgery involves lengthening some tendons and shortening other tendons to place the bones and joints in normal positions. A cast is applied to the foot after surgery to maintain its position while it heals.</p>

<strong>Aftercare</strong><p>The child will stay in the hospital for approximately two days after surgery. The foot will be casted and kept elevated, with ice packs used to reduce swelling and pain. Medications can be used for pain. The skin around the cast and the toes will be checked frequently for the first 48 hours to make sure that the circulation, movement, and feeling are maintained. Before leaving the hospital, the parent will be taught how to take care of the cast, which is usually left on for about three months. Skin irritations from the cast or incision infections may occur. Physical therapy is usually required after the cast is removed to strengthen the muscles in the repaired foot.</p>

Clubfoot deformity - illustration

Clubfoot is the most common congenital disorder of the lower extremity. One or both feet turn downward and inward. Genetic and environmental factors in the development of the fetus are the apparent causes.

Clubfoot deformity

illustration
Clubfoot repair - series

Presentation

Review Date: 11/6/2023

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.

Content is best viewed in IE9 or above, Firefox and Google Chrome browser.