Clubfoot (Talipes equinovarus) is the birth defect
that affects the lower extremities the most often. A malformed
ankle bone (talus) and an Achilles' tendon that is shorter than normal
is what causes the foot to take on the appearance of a club. Clubfoot
causes the foot to point down, and turn inward, and also causes the toes to
curl toward the heel. Clubfoot affects approximately 1 out of every
1,000 babies born. It usually occurs on both feet and is more commonly
seen in newborn boys than it is in newborn girls. Spina bifida and other
birth defects have been proven to be associated with clubfoot. With
proper treatment, clubfoot can be corrected.
Several factors such as genetics and problems during pregnancy are known to
cause clubfoot. In some cases it is inherited, but, it is undetermined
how it is transmitted. Studies have shown that when one child in the
family is born with clubfoot, any future children stand a 1 in 35 chance of
having clubfoot. If the parent was born with clubfoot, their children have
a 1 in 10 chance of being born with this deformity. In families that
have no history of this deformity, if their child is born with clubfoot, it is
usually from a problem during pregnancy that happened while their bodies were
being formed in the womb. It has also been found that abnormalities
in the muscles and the deformities in the tendons may also be a cause of
clubfoot.
The severity of clubfoot can vary greatly from person to person. The
deformity may be hard to see, or could be so severe that the toes may be bent
so far back that they touch the ankle. Whether it is mild or extreme,
all cases of clubfoot have certain traits in common such as:
- ankle bone is deformed
- the Achilles' tendon is shorter than normal
- the heel bone is flatter and shorter than normal
In some cases of this deformity, the muscles in the calf become underdeveloped
and shorter than normal, and the tissue located around the clubfoot become permanently
contracted. In this position, the foot stays tight like a clinched fist
and efforts to pull it back into its normal position are futile. Most
patients who suffer from clubfoot say that they suffer no pain. However,
people with arthritis and the elderly have expressed feeling pain.
Diagnosing clubfoot in its infancy is very important. Since the
deformity is very obvious, it is easily diagnosed. If the deformity
seems subtle, it will require further examination to diagnose true clubfoot
from pigeon-toe (apparent clubfoot). Pigeon-toe is caused when the fetus
stays in the position that would curl their feet like clubfoot. This is
easily corrected after birth. Another form of apparent clubfoot is when
there is an inversion of the feet that results from the peroneal progressive
muscular atrophy and dystrophy. In children born with clubfoot, when x-rayed
it shows the ankle bone and heel bone are on top of each other.
Clubfoot is usually treated in three separate stages:
- The first stage is correcting the deformity.
- The second stage consists of trying to maintain the correction while the
foot regains its muscle balance.
- The third stage is basically a maintenance process that the physician
will observe the foot over a period of years to aid in preventing the
deformity from returning.
Treatment to correct clubfoot in newborns should begin at once, since the
infant's foot is mostly made up of cartilage, and the muscles and tendons are
still being formed. The best time to start treatment on newborns is within
the first few days of their life.
There have been many therapeutic methods that were found to be effective in
the treatment of clubfoot. A simple manipulation using a cast, which
holds the foot in one position, for several days, and then recasting the foot
into a more corrective position, until the foot is in the desired position.
However, instead of recasting, the physician may use a procedure called the
"Kite method", which is the process of putting wedges into the cast to maneuver
the foot, instead of recasting each time. After the clubfoot has been
corrected, physicians suggest using exercise, splints, and orthopedic shoes to
help maintain proper foot alignment. The average length of correcting
clubfoot through casting usually takes 3 to 6 months.
Clubfoot that resists treatment may require surgery. In severe
cases, bone surgery may have to be performed. After the surgery, the foot
is put into a cast to help maintain the corrective surgery. In cases of
clubfoot that have had corrective surgery, it is rare for the clubfoot to be
totally correctable. The surgery usually only helps with the outward appearance
of the deformity.
It is important to diagnose clubfoot as early as possible after birth.
- Look for deformities in the baby's feet.
- If a deformity is found, it should be examined to determine whether it
is pigeon-toe or true clubfoot.
- Do not try to forcefully manipulate the clubfoot as you may cause more damage.
- If it is pigeon-toe, the foot can move with ease.
- If the child has undergone the casting process, their feet should be elevated
and the temperature and color of the foot should be checked every couple of
hours, in order to notice any changes.
- Check for swelling.
- The physician will warn parents to not allow the cast to get soft or
wear down. This will cause the casting process to lose its corrective ability.
- The child should exercise that foot daily and should wear corrective
shoes made for their specific deformity.
Source. Leibrandt, Thomas, Diseases, Causes and Diagnosis, 2001