My Child Has...

It occurs in about one in every 1,000 live births and affects boys twice as often as girls. Fifty percent of the cases of clubfoot affect both feet.

Often one gender (either male or female) is affected more frequently than the other in multifactorial traits. There appears to be a different "threshold of expression", which means that one gender is more likely to show the problem than the other gender. For example, clubfoot is twice as common in males as it is in females. Once a child has been born with clubfoot, the chance for it to happen again in a male or female child is about 4 percent overall. In other words, there is a 96 percent chance that another child would not be born with clubfoot.

• family history of clubfoot
• position of the baby in the uterus
• increased occurrences in those children with neuromuscular disorders, such as cerebral palsy (CP) and spina bifida
• oligohydramnios (decreased amount of amniotic fluid surrounding the fetus in the uterus) during pregnancy

At the time of birth, clubfoot is diagnosed by physical examination, with the finding of a foot which is in a fixed position, with the foot pointing downward and inward and inability to bring the foot back into normal position. X rays are confirmatory.

Diagnostic procedures of the foot may include:

• x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

• computerized tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called 'slices'), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

The symptoms of clubfoot may resemble other medical conditions of the foot. Always consult your child's physician for a diagnosis.

Alternative methods of treatment include surgical management which is required in approximately 10% of clubfeet with tendon and capsular releases of the bones. The more severe the foot deformity, the more likely surgical treatment will be required. Tendon transfers and osteotomies are required in a number of feet for residual deformity, even if casting is initially successful.

The "French" method of management is one in which prolonged physical therapy and taping is used; this appears to be quite effective as well. The results, however, are not as good as with corrective casting using the Ponseti method and for this reason, the Ponseti method is the treatment of choice for clubfeet at this point.

There are various methods of nonsurgical treatment for infants with clubfoot. These methods include serial manipulation and casting, taping, physical therapy and splinting, and use of a machine that provides continuous passive motion. A nonsurgical treatment should be the first type of treatment for clubfoot, regardless of how severe the deformity is.

According to the American Academy of Orthopaedic Surgeons (AAOS), the Ponseti method, which uses manipulation and casting, is the most frequently used method in the US to treat clubfoot. Most cases of clubfoot in infants can be corrected within 2 to 3 months using this method. It is recommended that Ponseti method treatment be started as soon as clubfoot as been diagnosed, even as soon as one week of age. The AAOS states infants with clubfoot occasionally have a deformity severe enough that manipulation and casting will not be effective.