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Clubfoot

Clubfoot

Clubfoot

Clubfoot is one of the most common conditions treated at Shriners Hospitals for Children — Greenville. The medical term for club feet is talipes equinovarus, which describes the position of the feet as pointed down (equinus) and in (varus). It may look like the foot is lying on its side with the bottom of the foot facing in towards the middle and the feet are usually stiff and difficult to get out of this position. This is different from other children's feet which may be curved but are very flexible. A baby can be born with one clubfoot or two club feet. If your child is born with two club feet, both feet can be treated at the same time.

What causes clubfoot?

There is no known cause for clubfoot but there are many ideas that might explain what happens, which include:

  • The baby’s foot stops growing at a certain point before birth
  • There is pressure on the baby’s foot in the mother’s womb
  • One of the bones in the foot doesn’t form correctly, which causes the rest of the foot to grow crooked
  • Some of the muscles in the foot do not form correctly and this causes the bones to grow crooked

How often does clubfoot occur?

Clubfoot is one of the most common birth defects. Severe forms of clubfoot affect some 5,000 babies (about one in 735) born in the United States each year. Boys are affected with severe forms of clubfoot twice as often as girls.

Famous people with clubfoot:

  • Kristie Yamaguchi: Gold medal winning ice skater
  • Troy Aikman: Played in the NFL for the Dallas Cowboys
  • Damon Wayans: Comedian, actor, scriptwriter, director, author
  • Mia Hamm: Women's National Soccer Team 1981-2004. 2 time FIFA World Player of the Year 2001 and 2002.

Evaluation and treatment of clubfoot

The usual treatment strategy is to correct the position of the clubfoot either by surgery or by a series of casts (Ponseti method), follow the foot as it grows and do what it takes to keep the foot in the best position possible. Sometimes an operation may be required during the growing years to maintain the position of the foot. The expected outcome is a foot which is near normal in shape, is comfortable in a standard shoe and functions comfortably with a walking-level intensity of activities.

Ponseti method

The Ponseti method has been around for about 50 years. It was named for Dr. Ignacio Ponseti. This treatment is started soon after your baby is born. During this time, the ligaments, joints and tendons are the most flexible. The Ponseti method includes gentle massage and moving parts of the foot to stretch the tight or shortened segments of the clubfoot slowly into a good position. The foot is then held in place with a long leg cast for about a week at a time. During this time, the muscles and ligaments stretch enough to allow a little more correction in the foot’s position. The cast is taken off and the foot is again massaged or stretched and moved into a better position. A cast is put on again and after about six weeks (and six casts) the foot is in a good position.

Tenotomy

To help get the foot in the best position, most babies with clubfoot will need to have their Achilles tendon lengthened. This is called a tenotomy. The Achilles tendon is a strong tendon that goes from the calf muscles to the heel. This tendon can be so tight that the foot will not go into the right position, but a tenotomy can fix this. This procedure allows the foot to go into the very best position. A cast is then put on for the next three weeks until the tendon fully heals. This last cast is taken off in the clinic and a special splint (brace) is used to keep the foot from moving back into the wrong position.

Bracing

This special brace is made of two high-top, open-toed shoes that are fixed on a metal bar. The brace must be worn full time (23 out of 24 hours a day) for the first three months. After this time, your child will be checked into the clinic. If the foot is doing well, your child will be able to wear the brace only at night and during naps. Wearing the brace exactly as instructed is important. If the brace is not used the right way each day, the foot may not stay corrected. Children with club feet will need to wear the brace until around the age of 4.

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