Clubfoot - a Real Mom's Tips

Pregnancy is a joyous and happy time. Occasionally, a mother learns that there may be some health complications with their unborn child. I learned during my eight month of pregnancy with my first child, that my unborn daughter had "bilateral clubfoot". I have also worked with several children afflected by this birth defect through my work as a Developmental Therapist. The name alone was frightening enough, and not being familiar with the diagnosis was even more petrifying. Knowing more about the diagnosis of clubfoot, and how to equip yourself with proper resources is a key factor in successfully managing the situation.
Clubfoot, also named talipes equinovarus, is a term used to define atypical positions and formation of the foot. Bilateral clubfoot is the name given when both feet are affected. Many cases of clubfoot are identified in utero through ultrasound examination, and most are successfully treated. Either one or both feet may be affected. Clubfoot affects 1 out of 1000 births, with more cases affecting boys than girls. Doctors are still unsure about what factors contribute to the development of an infant with clubfoot, but they do know that individuals with a family history of the condition are more likely to be diagnosed themselves. Often, other foot abnormalities of infancy and childhood are incorrectly diagnosed or referred to as clubfoot but may on fact be something else. Other similar disorders commonly diagnosed as clubfoot include metatarsus adductus (the child's feet bend inward from the middle part out to the toes), tibial torsion (child's lower leg, or tibia, is twisted), or femoral torsion (turning in of child's thigh, or femur bone).

A foot with true clubfoot the foot is turned severely to the side and it may look like that the top of the foot is where the bottom should be. If the clubfoot is truly congenital, the associated limb or limbs may also be affected. The involved foot, calf, and leg are typically smaller and shorter than the normal side. Clubfoot is not painful, but if left untreated, it can cause major delays in gross motor development in infancy and childhood, and discomfort and disability in adulthood.

Treatment of clubfoot is categorized into two main methods: surgical and non-surgical. Treatment of any kind should be started as soon after birth as possible to ensure the best results. All individuals share similarities in their own clubfoot, but there are also individual differences in presentation and severity. Therefore, proper treatment for your specific child should be discussed and planned with an experienced Orthopedic Surgeon. Weigh the risks and benefits of any treatment with your orthopedic surgeon, and always seek a second professional opinion if you have any doubts.

Non-surgical treatment of clubfoot includes stretching, serial casting, and the use of braces. The method of stretching and casting clubfeet is known as the "Ponseti method". This method was named after its originator, Dr. Ponseti, and has shown great success over past years. A "Ponseti Certified" orthopedic surgeon will cast your child's feet on a weekly basis. This casting turns the child's foot out to the typical position over a series of many weeks. This is known as "serial casting". The casts are change weekly in order to make room for the infant's rapidly growing feet, and to further the angle of the foot towards normal. Often times, the heel cord is "released" after several weeks of casting, allowing for greater flexibility. Casting is often continued for a period of time after this release. The final stage is comprised of a child wearing braces. The most common brace is called the "Dennis-Browne Bar", and is a brace made of two open-toed shoes, connected (in the middle of the shoe soles) by a heavy metal bar. This bar screws into the bottom of the soles of the shoes. The shoes are worn for a length of time determined by the orthopedic surgeon.

Occasionally, non-surgical treatment alone is not completely effective. Surgery may be done on your child's feet around the age of nine months. Tendons, joints, and ligaments are adjusted during the surgery, and casts are usually applied after to maintain the proper position of the foot after surgery. Monitoring of the foot and/or physical therapy is recommended to ensure the proper development of the child's foot.

Clubfoot is a common and very treatable birth defect. Often times, non-surgical methods are enough to correct the foot. It is a challenge for parents, nonetheless, and can lead to extreme stress and worry. If your child is affected by clubfoot, seek support from others who have experienced the diagnosis and treatment. Seek referrals from your orthopedic surgeon or primary care physician for resources and support groups in your area. Remember that prompt diagnosis and treatment of clubfoot most likely results in an unnoticeably corrected foot. My daughter was treated via the Ponseti Method, and began walking at one year of age, and has experienced no delays or malformation of her feet. You can make the difference in your child's life.