Clubfoot – Diagnosis and Treatment
Diagnosis
A health professional often detects clubfoot, also known as congenital talipes equinovarus, right after birth by visually checking the baby’s foot. The foot may turn inward (varus) and point downward (equinus).
The foot deformity is clear to see, so physical examination usually confirms the condition. Sometimes, an ultrasound during pregnancy, often around week 20, reveals signs of clubfoot before the baby is born.
In some cases, clinicians use X-rays to view the position of bones like the talus, navicular, and calcaneus, but these are rarely necessary. If a provider suspects clubfoot before birth, families can ask about treatment and possible genetic causes.
Common Steps in Diagnosis:
| Step | Method |
|---|---|
| Physical Exam | Inspecting foot shape and movement. |
| Prenatal Check | Ultrasound imaging to view the foot. |
| Further Testing | Occasional X-rays or genetic consultation. |
Treatment
Ponseti Technique
The Ponseti technique is the most common way to treat clubfoot. Because the bones and soft tissues in newborns are flexible, providers start this approach soon after birth.
The healthcare provider gently moves the baby’s foot into a better position and then puts a cast on the leg to hold it steady.
Each week, the provider removes the cast and moves the foot closer to the correct alignment before applying a new cast. Most children need several casts over a few months.
Toward the end of casting, many babies undergo a simple procedure to lengthen the Achilles tendon at the back of the ankle for improved motion. After shaping the clubfoot, the child wears special shoes attached to a brace.
Bracing Routine:
| Period | Bracing Frequency |
|---|---|
| First 3–6 months | All day and night. |
| Until ages 3–4 | Only at night and during naps. |
Braces keep the foot from turning back. If children do not wear the braces as directed, the clubfoot can return.
Parents should talk to a doctor if their child can’t tolerate the brace or if adjustments are needed as the child grows. Some children might need repeat casting if the foot starts to turn in before age two.
Daily Stretching and Splinting
Therapists in France often use the French approach, which focuses on stretching, taping, and splinting the foot every day. This process helps muscles and tendons slowly reach a more normal shape and position.
The treatment requires regular visits to a physical therapist, usually every week, especially in the first several months. Parents learn to stretch and tape the foot at home daily.
A minor procedure on the Achilles tendon often helps improve foot flexibility. Special splints hold the child’s foot in the right position.
This treatment continues for months, and parents need to stay consistent and involved with daily care until the child is about 2 to 3 years old.
What’s Involved in the French Method:
- Gentle stretching by a therapist and parents.
- Daily taping and use of a splint to keep the foot in place.
- Possible Achilles tendon procedure for extra flexibility.
- Frequent visits and close follow-up with therapists.
This method tends to work best for mild cases and relies on commitment from parents for ongoing home treatment.
Surgical Correction
Surgeons consider surgery when nonsurgical management, such as casting or stretching, does not fully correct the clubfoot.
Some children need an operation if the casting method does not give stable results, or if the foot continues turning inward as they get older.
Surgeons may recommend surgery between ages 3 and 5 if earlier treatments do not achieve or maintain good foot alignment.
The most common surgical procedure involves moving and reattaching the front tendon (tibialis anterior) to a different spot so the foot points forward more naturally. This adjustment helps balance the muscles and keeps the foot stable.
For very stiff or severe clubfoot, or when it is part of certain syndromes, surgeons may perform more extensive operations, such as releasing tight ligaments in the back and side of the ankle—a procedure known as a posterior or posteromedial release.
Important Aspects of Surgical Treatment:
- Corrects foot position by moving tendons or releasing tight tissues.
- Often followed by wearing a cast for up to eight weeks.
- Ongoing use of a brace or splint after the cast comes off for several years.
- Can lead to some loss of flexibility and a higher risk of stiffness or pain later in life.
Orthopedic specialists generally achieve positive surgical outcomes. Because surgery can make the foot less flexible, surgeons usually reserve it for those who have not responded to non-surgical treatments.
The goal is always to provide the best possible function and allow children to walk and play without pain or major limits.
Getting Ready for Your Child’s Clubfoot Visit
Meeting with a health professional about clubfoot is important, and preparing ahead of time can help the process go smoothly. Write down any questions that come to mind before the visit. A list helps you remember and discuss key points.
Some useful questions to ask include:
- How much experience do you have with treating clubfoot in babies?
- Do you need to refer my child to specialists?
- What treatment options are available, both surgical and non-surgical?
- What follow-up care will my child need?
- Will clubfoot affect my child’s ability to walk later in life?
Share any family history of clubfoot or genetic conditions, such as spina bifida or arthrogryposis, with the healthcare provider. If you experienced issues in pregnancy or had tests like amniocentesis, mention these as well.
Record important information and specific concerns—such as pediatric health issues or whether symptoms started in the first trimester—to guide the conversation.
Provide open and thorough information so the healthcare team can plan the best care for your child.
