Clubfoot is a congenital condition that can be diagnosed during pregnancy. Parents who have had the condition are more likely to have a child with clubfoot.

Overview

What is Clubfoot?

The medical name for Clubfoot is Talipes and this is something that children are born with and can affect one or both feet – around half of children with it will have it in both feet. The child’s foot or feet point down and inwards, with the soles facing each other.

Cause

This is relatively rare, affecting around one in every 1,000 infants. There are certain risk factors that may make it more likely: boys are more likely to have it then girls, and if one parent has had it then their children have a higher chance. The risk goes up even further if both parents were born with the condition.

Clubfoot also affects some ethnicities more than others, with a higher incidence in people from a Polynesian background, but a lower incidence in people who are Chinese.

Diagnosis

As this is a congenital condition and children are born with it, it can actually be diagnosed through an ultrasound. This can be as early as the second trimester, although there is a false-positive rate of up to 30%. The only way to make an accurate diagnosis is to wait for the child to be born, as it is usually evident in an early physical examination. Further investigations such as x-rays may help to determine how severe the clubfoot is and to assess treatment that is required or to track the progress of this.

Treatment

Casting

Over the past couple of decades, there have been changes in how the treatment of clubfoot is approached. In North America and the UK there is a type of casting called the Ponseti Method that is popular. This is based on gradually correcting the feet with weekly long-leg casting. Different parts of the feet are addressed with each casting to correct each of the aspects that are involved. In the final stage of the casting, the Achilles tendon may be cut in a small operation called a tenotomy. This is done to lengthen the Achilles tendon, which allows the ankle to flex up and the heel can then be placed flat on the floor. While this may sound concerning, studies have been carried out that have found the tendon grows back in children under the age of 11. Where the child is older, instead of cutting the Achilles tendon, small incisions can be used to help with lengthening it.

Once all phases of the casting approach have been carried out, the child needs to use a form of foot brace full-time for three months. Following this, part-time wear at night is required for 2-4 years.

The success rate of serial casting and cutting of the Achilles tendon is around 95%. The recurrence rate is around 37-47% and it has been shown that discontinuation of using the brace is strongly linked to recurrence, and this usually happens before the child turns four. An orthopaedic surgeon will monitor your child’s treatment and assess the need for an Achilles’ tendon cut. Some children may require orthopaedic surgery when older due to recurrence or gait problems.

Helpful resources

• Steps Charity: Understanding Clubfoot

• NHS: clubfoot