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Baby with clubfoot (equinovarus talipes), doctor utilizing Ponseti method

Internationally recognized care for clubfoot

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Clubfoot (talipes equinovarus) is a quite common, congenital deformity caused by shortened and tight tissues (tendons) that connect leg muscles to the foot. This affects the positioning of one or both feet and, if left untreated, may affect the ability to walk. Clubfoot is diagnosed before or at the time of birth and presents as one or both of the feet turning inward and downward. 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.

With the proper intervention and treatment, the foot or feet can be repositioned to an almost normal state, allowing complete freedom to enjoy running, jumping, sports and other routine activities of childhood.

Clubfoot occurs in approximately one in every 1,000 births and can sometimes be detected during prenatal ultrasounds. Clubfoot is a very treatable condition that rarely requires surgical intervention. Many all-star athletes, like world champion figure skater and Olympic gold medalist Kristi Yamaguchi and NFL quarterback Troy Aikman, were born with clubfoot.

Shriners Hospitals for Children specializes in research-backed treatment options designed to help children with clubfoot.

What causes clubfoot?

Clubfoot doesn't have a clear cause, but it may be related to a combination of genetic and environmental factors. Having a family history of clubfoot or having an underlying health condition or neuromuscular disorder are also risk factors. Clubfoot may also result from the baby’s positioning in the uterus or a decrease in the amniotic fluid that surrounds the baby during pregnancy. Still, many babies born with clubfoot may have none of these risk factors.

Types of clubfoot

Isolated (idiopathic) clubfoot, which is apparent at birth, is the most prevalent form of clubfoot. It is seen in children with no other medical issues.

Nonisolated clubfoot, on the other hand, is seen in combination with other genetic conditions or neuromuscular disorders, such as arthrogryposis or spina bifida.

Regardless of the type or the cause, clubfoot presentation is basically the same. With the right specialty care and treatment plan, most children with this condition can have a functional foot with minimal differences in appearance from the unaffected foot, or typical form.

Our treatment and management approaches

Clubfoot does not improve without treatment. Treatment generally begins shortly after diagnosis and takes into account the severity of the condition, your child’s age and medical history, and in some cases, the family’s treatment preference.

The goal of treatment is always the same – to prevent pain and correct the position of the foot. The expected outcome is a foot that is near normal in its shape and positioning, is comfortable in a standard shoe, and functions without discomfort. This may be acquired by nonsurgical or surgical means.

Nonsurgical clubfoot treatment

Nonsurgical treatments include:

  • Ponseti method: This is a widely used technique that is most effective when started shortly after birth when the ligaments, tendons and joints are most flexible.
    • Massage and casting: This method alternates between gentle foot massages to loosen tight or short segments, and then casting for brief periods of time to encourage desired positioning. This back and forth allows the foot to find its way into healthy alignment gradually.
    • Achilles tenotomy: In most cases (90%), babies will require an Achilles tenotomy following the period of massaging and casting. This quick procedure releases the tightness of and lengthens the Achilles tendon (heel cord) so that the foot is physically able to get into the proper position. Following the procedure, the child will spend several weeks in a cast while the tendon heals. When the cast is removed, the tendon will have regrown to a proper length, correcting the clubfoot.
    • Bracing: Though casting, and tenotomy when needed, can correct clubfoot, the condition can recur. To ensure the correction is permanent, your child will need to wear a brace (sometimes referred to as a “boots and bar”) for several years. In order for bracing to be successful, it must be worn as instructed. This usually translates to 23 hours a day for the first few months, then only during naps and at night until around age 4. The brace itself is constructed out of high-top, open-toed shoes that are supported by a metal bar.

Surgical clubfoot treatment

Clubfoot is often corrected with nonsurgical techniques, but sometimes cannot be fully corrected or, the condition may return. More severe deformities may not respond to stretching and therefore require surgical intervention. The surgical procedure generally involves the release and lengthening of the foot’s tight tendons in order to align the foot in a more normal position.

Conditions, treatments and services provided may vary by location. Please consult with the Shriners Hospitals for Children location nearest you. See zip code search feature to the right.

Request an Appointment

Most major insurance providers are accepted; however, insurance coverage is not required for care. Any child under 18 with a medical condition or medical need that is within the health care system’s scope of services, is eligible for care. Shriners Hospitals for Children offers financial assistance to those in need.

Find a Location Near You

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22 Locations Across North America

Location Specialties
  • Burn Care
  • Craniofacial and Cleft Lip/Palate
  • Neuromuscular
  • Orthopaedics
  • Orthotics and Prosthetics
  • Pediatric Surgery
  • Spinal Cord Injury
  • Sports Injury and Fractures
  • Therapy and Rehabilitation

Notice: Treatments and services vary by location. Contact nearest hospital for specific details.

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