Clubfoot

Right now, you probably have lots of questions: How serious is my child’s club foot? What will the treatment involve? What do we do first? We’ve provided some answers to your questions on this site, and our experts at Children’s Hospital Boston can explain the treatment steps for your child’s club foot when you meet with us.

What is club foot?
Club foot (talipes equinovarus) is a congenital (present at birth) foot deformity that affects boys twice as often as girls. The condition affects bones, muscles, tendons and blood vessels. It can be present in one or both feet, and there’s a 50 percent chance of its being bilateral (affecting both feet).

When does club foot show up, and what it does look like?
Club foot can usually be seen in a prenatal ultrasound, and is readily visible when a baby is born. The baby’s heel points downward, and the front half of the foot turns inward. The calf muscles on the club foot side are smaller than on the normal side, and the leg on the affected side is slightly shorter than on the other side. The foot itself is usually short and wide, and the heel cord (Achilles tendon) is tight.

What causes club foot?
Despite a great deal of study, the exact cause of club foot in isolation (not as part of a syndrome or other birth defect) is unknown. There have been some indications of a genetic cause, but these haven’t been confirmed. Most children who are born with a club foot don’t have a family history of the condition.

What is known is that if a baby boy has a club foot, there’s a 2.5 percent chance that his next-born sibling will have club foot, too. If a girl baby has a club foot, there’s a 6.5 percent chance that her next-born sibling will also have a club foot.

How common is club foot?

Club foot is a relatively common deformity, affecting about one of every 1,000 newborns.

Are there different types of club foot?

• A true (idiopathic) club foot accounts for the vast majority of cases. This type is stiff or rigid, and very hard to manipulate.
• The affected foot may be more flexible, with a condition known as positional club foot. This flexible type of club foot is caused by the baby's prenatal position in the uterus (often breech). Positional clubfoot can easily be positioned into a neutral (not curved) position by hand.
• A third type is syndrome club foot—in which the condition is part of a larger syndrome. This type is usually more severe and difficult to treat, with less positive outcomes.

How serious is club foot? Can it remain untreated?

Club foot is serious only if it’s left untreated. A child’s well-treated club foot is very functional, enabling the child to run and play freely. But if left untreated, the condition progresses and limits the child’s mobility.

Who’s at risk for developing club foot?
Risk factors may include:

• a family history of club foot
• genetic syndromes, such as Edwards syndrome (trisomy 18)
• neuromuscular disorders, such as cerebral palsy (CP) and spina bifida
• oligohydramnios (a decreased amount of amniotic fluid surrounding the fetus in the uterus) during pregnancy

Babies born with club foot may also be at increased risk of having an associated hip condition, developmental dysplasia of the hip (DDH). In DDH, the top of the thigh bone (femur) slips in and out of its socket because the socket is too shallow to keep the joint intact.

How does Children’s treat club foot?
Major surgery is rarely the first choice for treating club foot today. Instead, the Ponseti method (named for its originator, Dr. Ignacio Ponseti) manipulates the foot into correct position without major joint surgery. This is the standard treatment, and it usually begins shortly after birth.

The Ponseti method involves:

• a two to three-month regimen of stretching and casting, with weekly changes of the cast in clinic
• minor surgery (tenotomy) usually under local anesthesia to release and lengthen the Achilles tendon
• a years-long bracing regimen

Is my baby in pain?

No, club foot isn’t usually painful to the baby or child.

Will my child be OK?
Babies and children usually do very well today with the Ponseti regimen and good follow-up care. Major surgery is rarely needed to achieve a highly functional foot.

However, 20 to 30 percent of treated kids need additional intervention sometime in their childhood for tendon tightness, or to prevent recurrence.

Parents and children can be very heartened to know that some of America’s finest athletes had club foot as children. These include Pittsburgh Pirates infielder Freddy Sanchez; pro soccer star Mia Hamm; Olympic skater Kristi Yamaguchi; and Dallas Cowboys quarterback Troy Aikman.

Does Children’s do research on lower-extremity developmental conditions?

The clinical and basic science researchers in Children’s Orthopedic Centerare recognized throughout the world for their achievements in the field, including groundbreaking studies of the lower extremities. Our breakthroughs mean that we can provide your child with the most innovative care available.

For more on Children’s extensive orthopedic research, see Research & Innovation.

Causes

There are a significant number of ongoing studies to determine the exact cause of club foot, including at Children’s. There may be a genetic cause, but for most children who are born with a club foot, the cause is idiopathic (unknown).

Signs and symptoms

• The heel points downward, and the front half of the foot turns inward.
• The calf muscles on the affected side are smaller than on the normal side.
• The leg on the affected side is slightly shorter than on the other side.
• The foot itself is usually short and wide.
• The Achilles tendon is tight.

When to seek medical advice

If your child has club foot, your doctor will have observed the condition either in your fetal ultrasound before your baby’s birth or upon delivery of your baby. Your doctor will initiate treatment immediately after your baby is born.

Questions to ask your doctor

If your child is diagnosed with club foot, you may feel understandably anxious. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns get addressed.

Some of the questions you may want to ask include:

• Could you describe what’s wrong with my child’s foot (feet)?
• Are other tests needed to confirm this diagnosis?
• Is there, or could there be, damage to his tissues or blood vessels?
• What will my child’s treatment involve? Will he need surgery?
• How can you prevent recurrence?
• Could there be long-term effects? Pain? Arthritis?
• Could this condition affect my child’s ability to walk, run or play sports?
• How long should my child be followed by her care team?

Who’s at risk

• a child with a family history of club foot
• a baby with a genetic syndrome, such as Edwards syndrome (trisomy 18)
• a baby with a neuromuscular disorder, such as cerebral palsy (CP) and spina bifida

Complications

If a child and his parents strictly follow the doctor’s bracing regimen, treatment of club foot at Children’s usually takes place without complications and is largely complete by about age 4. But 20 to 30 percent of kids need additional treatment later in childhood for tendon tightness or to prevent recurrence.

Long-term outlook

Babies and children usually do very well today with the Ponseti regimen and close, consistent follow-up care. Major surgery is rarely needed to give a child a highly functional foot, but 20 to 30 percent of kids need more treatment sometime in their childhood for tendon tightness or recurrence of the condition.

Parents and children can be very heartened to know that many celebrated athletes had club foot as children: football quarterback Troy Aikman; Olympic skater Kristi Yamaguchi; baseball infielder Freddy Sanchez; and pro soccer player Mia Hamm.

Club foot glossary

See our extensive Glossary of Orthopedic Terms.