Congenital clubfoot is a complex abnormality of a baby’s foot that occurs while they develop in utero. It involves multiple joints, tendons and ligaments and can be broken down into four key abnormalities: a high arch, the forefoot and hindfoot/heel pointing inwards, and the heel pointing downwards.
Clubfoot can be associated with neuromuscular conditions such as spina bifida or arthrogryposis, but it most commonly occurs as an isolated abnormality in an otherwise healthy child. Clubfoot tends to run in families, but many times there is no family history of clubfoot.
It’s very important for new mothers to know that having a baby with clubfoot is not related to anything they did or didn’t do during pregnancy and they should in no way feel guilty for having a child with clubfoot.
Treatment for Clubfoot
“Fortunately, we have a very effective treatment for clubfoot and we expect great long-term function for your child, so that he or she can run and keep up with classmates at school,” says board-certified pediatric orthopedic surgeon Cheryl R. Lawing, MD.
“We use the treatment method of Ignacio Ponseti, which involves a series of casts that are applied in clinic and changed weekly. The casts gradually stretch your child’s foot into a better position and bring the joints of the foot into alignment. While almost all babies will cry during casting, it is a safe and well-tolerated way to correct your child’s foot abnormality.”
Dr. Lawing clarifies that casting can’t correct the equinus, or downwards point, to the foot in most children. For this component, a small surgery is needed. It typically takes 4 to 6 casts to get the foot corrected to the point of needing the minor surgery.
During the surgery, called a tendo Achilles tenotomy, the Achilles tendon is lengthened. Dr. Lawing explains, “This procedure is less complex than the large procedure that used to be performed, where multiple joints and tendons were released and lengthened and the incision is usually so small that stitches are not needed.”
Depending on your baby’s age, they will either be sent home the same day or kept overnight for observation. After the surgery, your baby will be in a cast for three additional weeks. On occasion, a cast change or two may be needed after the surgery for additional stretching.
Dr. Lawing continues, “Once your baby’s foot is corrected, we must continue to work to keep it from turning back in again. We do this with braces called a foot abduction orthosis. This brace will have boots for both of your baby’s feet, even if only one foot was involved with clubfoot, and a bar that connects the boots. Without bracing, there is an 80 – 90% chance that clubfoot will come back. Braces are typically worn 23 hours a day until around 8 or 9 months old. At this age, we transition to wearing the braces at night and nap time until 4 years old.”
Here to Restore Your Child’s Wholeness
Following treatment, children with clubfoot typically function very well and are expected to be able to run and play without issues. They should be able to wear normal shoes and long-term bracing is not expected. While the function of your child’s foot is expected to be good, the foot and calf muscles will always be a little smaller. This is most noticeable when the clubfoot affects one of your child’s feet.
About 20 – 30% of children with clubfoot end up needing surgery around preschool age to transfer a tendon to provide better balance. Dr. Lawing assures us, “Long-term studies show great function following this surgery if your child needs it.”
To learn more about clubfoot and its various treatments, go to AdventHealthforChildren.com/Orthopedics.
