Club Foot in Children

Club foot is among the most prevalent of the lower extremity deformities. One or two babies per 1,000 live births will have club foot. Infants with the condition have a foot that is turned inward, often so markedly that the foot faces sideways. In severe cases, the foot will even face upward. The fixed inward rotation of the foot is due to abnormally short and tight tendons pulling the foot into an inward twist. Often, the bottom of the foot is deeply creased.

Club Foot Factors

The cause of club foot remains a mystery but we know that certain babies are more likely to have it:

• Boys (twice as often as girls)
• Multiples (e.g., twins, triplets)
• Children with multiple nervous system disorders

Club Foot vs. Club Feet

The incidence of club foot on one foot versus two is equally distributed on a 50/50 basis. Children with club foot on only one side tend to have a more pronounced shortening of the affected leg and foot.

Club Foot Diagnosis

Increasingly, club foot is diagnosed prenatally at a 16-week ultrasound, providing parents the opportunity to meet with a pediatric orthopedist prior to birth to discuss the diagnosis and treatment. Otherwise, the condition is identified during the newborn’s first physical exam. This exam will include the baby’s prenatal history and birth information as well as the parents’ family medical history. Because infants born with club foot will have a higher risk for developmental dysplasia of the hip (DDH), the doctor will perform a detailed hip examination to make sure the hip is stable.

Club Foot Treatment

The goal of treatment—for the foot to achieve full and painless functionality—is not only attainable but frequently met through nonoperative treatment. Beginning treatment immediately after birth is critical to an active, healthy life for the infant born with club foot.

The treatment plan for club foot is customized according to the newborn’s age, overall health status, and condition. Without treatment your child’s foot deformity will worsen over time. Children with untreated club foot are unable to walk normally and will have lifelong foot pain.

To illustrate the difference nonoperative treatment makes, consider how different the lives of successful professional athletes Troy Aikman and Mia Hamm—each born with club foot —would be if they hadn’t received treatment for their condition as young children.

Nonsurgical Treatment

The first line of treatment is always nonsurgical, regardless of condition severity. For isolated clubfoot, in which the patient has no other deformities or medical issues, nonsurgical treatment initiated early is usually all that is necessary. Primary nonsurgical treatment options include:

Ponseti Method

This widely-used, proven treatment method, initiated early in newborns, uses a stepwise approach:

• Stretching and bracing:
  The method uses gentle stretching as the first step in correcting the foot deformity. When the foot is stretched into the correct position, a toe-to-thigh cast is applied to hold the feet in place. In each subsequent week, the stretching is followed by the application of a new cast to retain and advance the foot’s progression. This method keeps foot ligaments soft and flexible, allowing bones to gradually shift into correct alignment.
• Achilles tenotomy:
  Following the stretching-and-bracing period, the next step in the Ponseti Method is the Achilles tenotomy (necessary in 90 percent of babies with club foot). During this minor procedure, the Achilles tendon is cut to alleviate tightness in the Achilles tendon. The cut is so tiny that stitches are not needed. As the tendon heals, it is protected by new casting. In only three weeks, the Achilles tendon will regrow to a normal length and the correction of club foot is complete.
• Continued bracing (maintenance):
  To prevent reoccurrence, children with club foot corrected by the Ponseti Method must continue to wear a brace for a few years, full time at first but gradually decreased to only during naps and at night. This phase of bracing ensures that the foot will stay in its corrected position.

French Method

The French method is an alternative to the Ponseti Method, requiring more parental participation. The French Method’s regimen is ideally initiated shortly after birth and includes stretching, mobilization, and taping. On a daily basis, the infant’s foot is stretched, then taped into place and splinted to retain the range-of-motion improvements gained by the stretching. The French Method requires three physical therapy sessions each week in addition to a mandatory daily stretching regimen carried out at home by the parents or guardians.

Babies usually show marked improvement after three months, and the number of physical therapy sessions can be tapered. As with the Ponseti Method, infants treated with the French Method usually require an Achilles tenotomy and continuation of the method’s regimen for a few years.

Surgical Treatment

In some instances — including parental difficulty in following nonsurgical methods or severe deformity—surgical treatment is needed to align the foot properly. Surgical intervention for club foot falls into two categories:

• Minor surgery for a baby whose foot has been partially corrected by a nonsurgical method entails a surgical focus only on those tendons and joints that are contributing to the deformity.
• Major reconstructive surgery entails the operative release of multiple tendons and ligaments in the foot. Following that procedure, a stabilization process to retain corrections through the use of pins and a casting for eight to ten weeks. Orthodics are typically used for a year after the surgery.