Talipes equinovarus, or clubfoot, is a congenital deformity affecting the foot's major structures, including bones, muscles, and skin. It's defined by the classic inward deviation of the affected foot/feet at birth.
What You Need To Know About Clubfoot
What is Clubfoot?
Clubfoot — known by the names talipes equinovarus (TEV) or congenital talipes equinovarus (CTEV) — occurs when a newborn's foot or feet rotates downwards or inwards, causing the soles of the feet to face one another. Because the tissues connecting muscles to the tendons in the foot are abnormally short, there is improper foot alignment. It occurs twice as commonly in boys than girls and affects roughly 1 in 1000 births. Around half of the cases affect a single foot, with the other half afflicting both feet (known as bilateral clubfoot).
There are three different types of congenital clubfoot: Idiopathic, neurogenic, and syndromic. Idiopathic cases are the most common type of clubfoot and do not have a known cause. Neurogenic clubfoot develops due to an underlying neurologic condition, such as spina bifida, cerebral palsy, or spinal cord compression. Lastly, syndromic clubfoot develops due to an existing condition, such as arthrogryposis, tibial hemimelia constriction band syndrome, or diastrophic dwarfism.
If you are concerned about your child's clubfoot and want to learn more about diagnosis and treatment, schedule an appointment with a Resurgens Orthopaedics' physician today.
What Causes Clubfoot?
Clubfoot develops in the womb. While genetic factors may play a role, the exact cause of it is unknown. The position of the fetus in the uterus is not a factor. Still, skeletal abnormalities such as spina bifida or hip conditions like hip dysplasia increase the likelihood to develop clubfoot. Also, shortened Achilles tendons may cause the foot to turn inwards or outwards.
Some physicians believe that disruptions in the neuromuscular pathway, spinal cord, or nerves may be clubfoot causes. Also, environmental factors play a role. For instance, mothers who smoke cigarettes or have diabetes are commonly linked to clubfoot development.
Symptoms of Clubfoot
Clubfoot typically involves a significant bend of the ankle inward, with corresponding tight muscles along the inside of the foot, the ankle, and the Achilles tendon. The leg on the affected side tends to be shorter. The calf muscles on the affected side grow to be smaller. The foot itself tends to be smaller and wider. As a result of the above, the affected foot can form a 90-degree angle relative to the lower leg.
Infants with clubfoot may display the following symptoms:
Shortened leg or foot
The top of the foot twists downward or inward, increasing the arch of the foot
In severe cases, the foot may appear to be upside down
How Clubfoot is Diagnosed?
A physician can diagnose a clubfoot in several different ways. Often, a clubfoot is visible at birth, but a doctor can identify it using ultrasound as early as 12 weeks into the pregnancy.
Once the child is born, a physician can quickly diagnose clubfoot by examining the foot's shape and positioning. A physician may suggest using X-rays to determine the severity of the clubfoot. Diagnostic imaging is important because it helps create your individualized treatment plan.
A clubfoot will not improve without early treatment. Physicians will often suggest therapies within several weeks of birth to help improve the foot's functionality and reduce pain. Since a newborn's bones, joints, and tendons are extremely flexible, it is advantageous to pursue treatment as soon as possible. There are both surgical and non-surgical approaches to treatment.
The most common non-surgical clubfoot treatment is through stretching and casting. A specialist will begin treatment by correcting the baby's foot's position and applying a plaster cast to the toes and thigh to hold the position. A therapist will perform the procedure weekly, and during each session, they will readjust the plaster cast.
The entire process requires four to ten sessions. The procedure should be comfortable as the foot gradually shifts into a correct position. A physician may suggest a minor surgery following treatment to release the Achilles tendon. The child will wear special boots to brace and hold the foot in position for up to three months to prevent relapse.
Another non-surgical treatment for clubfoot involves assisted daily stretching, exercises, and massages to move the foot into a correct position. A physical therapist will administer the first three months of treatment and then recommend an at-home treatment plan to continue realignment.
An orthopedic surgeon can help correct a clubfoot through several methods to adjust tendons, ligaments, and joints in the foot or ankle. A surgeon may release the Achilles tendon to reposition the foot or release soft tissue structures in the foot. A physician will stabilize the foot using pins or a cast.
During clubfoot surgery, a doctor may also have to lengthen or reposition tendons or ligaments in the foot. During recovery, the surgeon will place the foot in a cast or brace for several months. Unfortunately, surgery may lead to pain, stiffness, or overcorrection. But in most cases, the baby will be able to grow up wearing regular shoes and living a healthy, pain-free life.
Learn more about the Foot and Ankle Center at Resurgens Orthopaedics.