Clubfoot deformity is a congenital malformation, which, if left untreated, causes the child to walk on the lateral border of the foot. The Latin term for clubfoot is ‘talipes equinovarus’ which describes the three essential elements of the deformity: the heel is in equinus, the hindfoot is in varus, and the forefoot is supinated and adducted. The deformity is easily diagnosed enabling treatment to begin soon after birth. There are two general types of clubfoot deformity. The most common type, idiopathic clubfoot, occurs in isolation, and the second type occurs in association with other congenital deformities.
During infancy clubfoot does not cause pain. In fact, children will begin to stand and to walk at normal developmental stages. If left untreated, the child will not be able to wear shoes, and the foot will eventually become painful prohibiting participation in most athletics and certain forms of employment.
Physical examination of an infant with clubfoot will demonstrate the typical findings including hindfoot varus, heel equinus, and forefoot supination and adduction. The rigidity of the foot can help determine whether nonoperative treatment will be effective. The child should also have a careful examination of the hips, neck and spine to assess for the presence of associated conditions.
X-rays of the feet are not required to diagnose clubfoot. Following treatment x-rays are used to assess the development of the bones in the foot.
There is no known cause of idiopathic clubfoot deformity. While there is a definite genetic contribution to the development of clubfoot deformity, other potential causes include viral infection and lack of sufficient amniotic fluid. Clubfoot can also be associated with certain congenital problems including myelomeningocoele, Streeter’s syndrome, arthrogryposis, and certain forms of dwarfism.
The GOAL of treatment is to provide a stable normally positioned foot by the time the child reaches walking age. Treatment begins soon after birth and occurs in stages. Initially, gentle manipulation with casting or taping is used to gradually correct the position of the foot. Traditionally, weekly casting has been used to achieve this correction. Recently, daily physical therapy followed by a special taping procedure has been proved very effective in correcting mild and moderate idiopathic clubfoot deformity. If closed manipulative treatment fails, then surgical correction is required. The operation, called a ‘posteromedial release’ is performed when the child is at least six months old. It requires a general anesthetic, and the child must remain overnight in the hospital. Following surgery the foot is maintained in a cast for approximately three months. After casting, most children are fitted with special shoes, which are worn for about one year. The children must be examined periodically until they are fully grown.
All children with clubfoot deformity have some degree of weakness in the affected foot and leg due to under-development of the involved muscles. This does not usually adversely affect the child’s ability to participate in activities. Approximately 25 percent of patients who are surgically treated for clubfoot deformity will require another operation before they are fully grown. Other complications of clubfoot are stiffness and over-correction.