• Clubfoot

    Definition

    Clubfoot is a deformity of the foot that causes the foot to turn inward and downward. The Achilles tendon becomes tight, which pulls the heel upward toward the leg and prevents the foot from being able to sit flat on the ground. A clubfoot is usually smaller than a normal-sized foot.

    Causes

    Clubfoot is caused by a deformity in the development of the muscles, tendons, and bones of the foot. It is present at birth. The cause of clubfoot is unknown. There is some belief that clubfoot can be inherited in some cases. It is not thought to be caused by position in the womb.
    Achilles Tendon and Related Muscles
    Achilles Tendon action
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    Risk Factors

    Clubfoot occurs more often in men than in women. Because the cause of clubfoot is not understood, not many of the risk factors for this condition are known. However, having a family history of clubfoot may increase your chance of developing it.

    Symptoms

    Symptoms include:
      At birth, 1 or both feet that:
      • Turn inward and downward, and will not straighten
      • Are slightly smaller than normal
    • Calf muscle slightly smaller than normal

    Diagnosis

    Clubfoot is easily diagnosed during a physical examination, but an x-ray of the foot will also be taken. The condition can often be diagnosed before birth during an ultrasound examination.
    Prenatal Ultrasound
    Fetal Ultrasound
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    Treatment

    Clubfoot can be corrected, but it is best to start treatment as early as possible—sometimes right after birth. Treatment options include:

    Casting

    With casting, the foot is manually moved into a better position. It is placed in a series of casts. A new cast is put on every week for 5-10 weeks to stretch the soft tissues of the foot and reshape it.
    After the initial casting procedure is completed, a brace is used at night and during naps.

    Surgery

    More extensive surgery may be done to correct the deformed tendons and muscles in severe cases that do not respond to casting. When necessary, surgery is most commonly done within the first year of life.

    Prevention

    There is no known way to prevent clubfoot, because the cause is unknown.

    RESOURCES

    American Orthopedic Foot & Ankle Society http://www.aofas.org

    OrthoInfo—American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Foundation http://www.canorth.org

    Health Canada http://www.hc-sc.gc.ca

    References

    Clubfoot. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00255. Updated September 2014. Accessed February 11, 2016.

    Clubfoot. Seattle Children's Hospital website. Available at: http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/clubfoot/. Accessed February 11, 2016.

    Clubfoot. Massachusetts General Hospital Orthopedic Surgery website. Available at: http://www.massgeneral.org/ortho/services/pediatrics/clubfoot.aspx. Accessed February 11, 2016.

    Eastwood DM, Sanghrajka AP. Guided growth: recent advances in a deep-rooted concept. J Bone Joint Surg Br. 2011;93(1):12-18.

    van Bosse HJ. Ponseti treatment for clubfeet: an international perspective. Curr Opin Pediatr. 2011;23(1):41-45.

    Zionts LE, Dietz FR. Bracing following correction of idiopathic clubfoot using the Ponseti method. J Am Acad Orthop Surg. 2010;18(8):486-493.

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