Clubfoot Causes, Treatment & Prevention: A Complete Guide

Clubfoot is a common birth defect in which a baby’s foot or feet twist inward at birth. In this condition, the bottom of the foot faces sideways or even upward. Medically it is known as talipes equinovarus. Clubfoot affects about 1 in every 1,000 newborns. 

Here we will explain what clubfoot is, its causes, symptoms, how doctors diagnose it, and review the different treatment and prevention options available.

What Is Clubfoot?

Clubfoot is a birth defect that changes the position of the foot. Babies with clubfoot have a foot that points inward and downward. The condition develops before birth when the tendons in the baby’s leg and foot become too short and tight. These tendons actively pull the foot into a twisted shape.

In clubfoot, the tendons (tissues that connect muscles to bones) are shorter and tighter than normal. This tightness pulls the foot into an unusual position. Doctors see clubfoot in both feet in about half of affected babies. Although clubfoot does not hurt newborns, if you leave it untreated, it can create walking difficulties, foot infections, and long-term joint problems.

Doctors classify clubfoot into two main types:

Isolated (Idiopathic) Clubfoot

This form is the most common. In isolated clubfoot, the baby’s foot is the only issue. The cause remains unknown, and the condition does not link to any other medical problems.

Non Isolated Clubfoot

In this type, clubfoot appears along with other health issues. Conditions such as joint problems (arthrogryposis) or neural tube defects like spina bifida, which affect the brain, spine, and spinal cord, may accompany clubfoot.

Symptoms of Clubfoot

The most obvious sign of clubfoot is that one or both of a baby’s feet twist inward. Other symptoms include:

• The foot often appears curved or kidney-shaped.
• A deep crease may form on the inside of the foot.
• The foot sometimes develops a higher-than-normal arch, known as a cavus foot deformity.
• Smaller Calf Muscle
• Shorter Foot
• Stiff Ankle

What Causes Clubfoot?

The exact cause of clubfoot remains unclear. Experts believe that clubfoot results from a mix of genetic and environmental factors.

Genetic Factors

Genes actively shape many aspects of a child’s growth and development. Changes in one or more genes may cause clubfoot. When a parent or sibling has clubfoot, the baby faces a higher risk of developing the condition.

Environmental Factors

Certain environmental factors may increase the risk of clubfoot, including:

1. Exposure to tobacco smoke or the use of drugs during pregnancy can raise the risk of birth defects such as clubfoot.
2. Oligohydramnios is a condition where there is not enough amniotic fluid surrounding the baby. It may relate to clubfoot.
3. Infections like the Zika virus during pregnancy can also elevate the risk.

Boys face about twice the risk of developing clubfoot compared to girls. In addition, babies with other birth defects, such as spina bifida or cerebral palsy have a higher chance of developing clubfoot.

How Does Clubfoot Affect Your Baby?

Clubfoot does not usually cause pain in newborns, and many babies do not seem troubled by it at first. However, without treatment, clubfoot creates problems when the child starts to stand and walk. If you leave clubfoot untreated, it can cause:

1. The abnormal foot position forces the child to walk on the side or top of the foot, leading to an unusual gait.
2. Walking on the wrong part of the foot may cause calluses and can even lead to infections.
3. Over time, the improper alignment may trigger arthritis and joint pain.
4. An incorrectly shaped foot may not fit standard shoes and can cause discomfort.

Diagnosis and Tests

Doctors often diagnose clubfoot during a prenatal ultrasound. This early detection allows parents to prepare for treatment as soon as the baby is born. If clubfoot does not appear during pregnancy, doctors usually notice it during the baby’s first physical exam.

Sometimes, doctors order an X-ray to confirm the diagnosis and assess the severity of the condition.

Treatment Options for Clubfoot

Starting treatment early is essential. Experts recommend beginning treatment within the first two weeks of a baby’s life. A dedicated team that includes a pediatric orthopedic specialist, an orthopedic surgeon, and a physical therapist typically manages treatment.

Non-Surgical Treatments

Over recent decades, non-surgical methods have become the preferred treatment for clubfoot. These methods correct the foot’s position without the need for extensive surgery.

The Ponseti Method

The Ponseti method stands as the most common treatment for clubfoot. It uses a series of gentle stretches and casts to gradually correct the foot’s position. The process follows these steps:

• A doctor gently stretches the baby’s foot toward the correct position and then applies a cast that runs from the toes to the upper thigh. The cast holds the foot in its new position.
• Every 4 to 7 days, the doctor removes the cast, stretches the foot a little more, and applies a new cast. This gradual process continues for about 2 to 3 months.
• Achilles Tenotomy: Often, before applying the final cast, the doctor performs an Achilles tenotomy. In this brief procedure, the doctor makes a small cut in the tight tendon at the back of the heel to allow it to lengthen. The tendon heals within approximately 3 weeks before the final cast secures the correction.

After the casting phase, the baby wears a brace commonly called “boots and bar” to maintain the proper position. The brace stays on full-time for three months and then usually only during naps or at night for up to four years. Consistent use of the brace helps prevent a relapse.

The French Method

The French method, also known as functional physical therapy, involves daily stretching, taping, and splinting of the foot. A physical therapist shows parents how to perform these exercises at home. The treatment follows this routine:

• Daily Exercises: The therapist stretches the baby’s foot toward the correct position every day and secures it with tape and splints.
• Frequent Monitoring: The therapist visits several times a week to check progress and adjust the splints as needed.

Parents use the French method daily for about two months and then less frequently until the baby reaches 3 months of age. Like the Ponseti method, an Achilles tenotomy may also be necessary to achieve the best result.

Bracing

After completing the main treatment, you must use a brace to maintain the corrected position of the foot. The brace typically consists of special shoes connected by a bar. Following the doctor’s schedule for brace use helps prevent the foot from reverting to its original, twisted shape. The schedule generally includes:

• Wearing the brace every day for the first three months after treatment.
• After three months, the brace usually stays on only during naps and at night for up to four years.

Surgery

Doctors consider surgery when non-surgical methods do not fully correct the clubfoot or if the deformity is severe. The goal of surgery is to release or lengthen the tight tendons and ligaments and to correct the foot’s alignment. The surgical process typically follows these steps:

The surgeon makes a small incision, lengthens the tight Achilles tendon, and corrects any other soft tissue problems in the foot. Pins may hold the foot in the correct position.

After surgery, the doctor casts the foot for several weeks to maintain the new alignment. Later, the pins are removed, and the doctor may apply a new cast for about four more weeks.

Although surgery can correct clubfoot effectively, it carries risks such as infection, nerve injury, and stiffness. Most healthcare providers therefore prefer non-surgical methods whenever possible.

Prevention and Long-Term Care

Because doctors do not fully understand the exact cause of clubfoot, no method guarantees prevention. However, you can support a healthy pregnancy by taking steps that may lower the risk of birth defects:

• Schedule a checkup before becoming pregnant to confirm that you are in good health.
• Do not smoke or drink alcohol during pregnancy and avoid secondhand smoke as well.
• Only use medications approved by your healthcare provider.
• Get tested and treated for infections like the Zika virus before and during pregnancy.
• Follow a balanced diet, exercise moderately, and get enough sleep to support overall health.

Conclusion

Clubfoot remains a manageable condition when doctors catch it early and treat it properly. Using a combination of non-surgical methods such as the Ponseti and French techniques, followed by consistent bracing, most children achieve a near-normal foot position. In cases where these methods do not fully correct the deformity, surgery remains an option, though doctors usually reserve it as a last resort.

A healthy pregnancy, regular medical checkups, and careful follow-up after birth all contribute to a positive outcome. Parents who take a proactive approach by adopting a healthy lifestyle and following their doctor’s instructions set the stage for a successful future. Early treatment, consistent care, and a supportive team all make a significant difference in helping your child lead a normal, active life.