Cleft Foot

At Children’s Hospital Boston, our orthopedic experts know that it’s distressing to learn that your baby has a cleft foot. We’ve pioneered innovative surgical treatments for children with all types and variations of cleft foot.

What is cleft foot?

Cleft foot is a rare congenital (meaning your baby was born with it) anomaly in which the foot didn’t develop properly during fetal development. This causes the affected foot to have missing toes, a V-shaped cleft and other anatomical differences.

What causes cleft foot?

Cleft foot is generally understood to have a genetic cause.

Cleft foot can occur by itself; with cleft hand (ectrodactyly, also called split hand-split foot malformation); or as part of a genetic syndrome.

How common is cleft foot?
Cleft foot is very rare, affecting fewer than 1 in 1,000,000 babies.

How will having a cleft foot affect my child?
It really depends on the severity of the problem. Surgery can usually improve the foot’s function, especially since the heel, which remains normal, is the area of the foot that’s most needed for walking. So, for both cosmetic and cost reasons, the main issue is: Can your child’s affected foot fit into an off-the-shelf shoe? Our doctors work hard to re-shape the foot so that a child can wear regular shoes, rather than specially made ones.

Does cleft foot cause my baby pain?
No, a child doesn’t typically experience pain as a result of cleft foot.

What are the signs and symptoms of cleft foot?

A cleft foot is visible to the eye.

How is a cleft foot diagnosed?

A cleft foot develops during fetal development, when the bones of the foot are forming. The condition can sometimes be detected on a routine prenatal ultrasound. After the baby is born, the deformity is visible.

Details of the diagnosis are usually confirmed through a physical exam and x-rays. Your child’s doctor will closely evaluate every anatomic structure of the foot, determining what is present or absent, normal or abnormal. The doctor will take particular care to assess the soft tissue specifics of the foot, such as muscles, ligaments, blood vessels and nerves.

Can cleft foot be associated with other conditions?
In the majority of children who have it, a cleft foot may be an isolated occurrence, affecting only her foot. But your doctor will also check for any associated deformities or syndromes.

How is cleft foot treated, and at what age?

In all but mild cases of cleft foot, the condition is treated surgically, usually when a child is 1 to 2 years old and can tolerate anesthesia and surgery well. There are several surgical approaches that surgeons can take, but all surgeries aim to:

• increase foot function
• decrease the deformity by closing the cleft

Causes

There’s a genetic basis for typical cleft feet. The condition can occur by itself (in isolation), or as part of ectrodactyly (split hand-split foot malformation) or a genetic syndrome.

Signs and symptoms

Signs of cleft foot are visible at birth, and increasingly, on prenatal ultrasound.

• The baby’s foot has missing toes, a V-shaped cleft and possibly other anomalies.

When to see a specialist

If a fetal ultrasound reveals that your baby has a cleft foot, you’ll be referred to an orthopedic specialist, who will help you plan for your child’s care after she’s born. If you haven’t learned during your pregnancy that your child has a foot problem, the cleft foot will be visible when your baby is born, and you will be referred to a lower limb specialist.

Questions to ask your doctor

Lots of parents find it helpful to write down questions as they occur to them before their appointment—that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed.

Some questions you could ask are:

• Why did my child develop a cleft foot? (You would ask this if neither your partner nor you have a cleft foot.)
• What will x-rays reveal beyond what is visible to the eye?
• What are the associated conditions, if any, with a cleft foot?
• Is surgery necessary, and if so, what does it entail? Are there alternative therapies?
• Will my child be OK after surgery? Could there be complications?
• Will my child recover full function of her foot? Will it look OK?
• Will there be restrictions on her activities or capabilities?
• Will my child need physical therapy?
• What will be the long-term effects?
• What can we do at home?

Complications

As your child grows, some gaps and deformities that were reconstructed by original surgery can recur. In these cases, additional surgery or surgeries may be needed.

Long-term outlook

Your child’s outlook depends on how severe her cleft foot is, as well as the extent of any associated conditions.

The quality of the reconstruction of your child’s foot depends on the severity of her original malformation. You can expect that she will have a functional foot and an improvement in the aesthetics of her foot. Alignment of her toes should improve.

For parents

If your baby was born with a cleft foot—or if you’re expecting a child who will have a cleft foot—you’re probably disappointed that your child and your family are facing a complicated path so early in her life. If you feel frustrated or depressed, speak to your doctor or counselor to get help. Professionals in Children’s Center for Families can provide you with important resources and referrals.

Cleft foot glossary

• The Center for Families at Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
   
• autosomal dominant: genetically predisposed to have the same trait as a parent; in the case of cleft foot, if a parent has the condition the child has a strong chance of having it, as well.
   
• cleft foot: the foot has a deep cleft that extends towards the ankle; is missing toes; and can have highly variable deformities. Clefts are usually V-shaped.
   
• congenital: present at birth
   
• embryonic development: development of the fetus in the womb
   
• in isolation: a condition that occurs “by itself,” rather than as part of a larger syndrome
   
• in utero: in the womb (uterus)
   
• occupational and physical therapy: services offered by trained professionals to help restore function or (re)teach basic life skills, like dressing oneself or grasping objects
   
• orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
   
• orthopedic surgeon, orthopedist: a physician specializing in surgical and non-surgical treatment of the spine, skeletal system and associated muscles, joins and ligaments
   
• post-operative (post-op): occurring after surgery
   
• prenatal (fetal) ultrasound: ultrasound performed at several stages of pregnancy; can often detect cleft foot in the fetus
   
• pre-operative (pre-op): occurring before surgery
   
• range of motion (ROM) exercises:physical therapy exercises designed to improve or restore flexion and extension of joints
   
• reconstructive surgery: surgery performed to repair and/or restore a body part to normal or as near normal as possible
• sporadic: occurring without apparent cause
   
• x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film

  Our complete orthopedic team

  Children’s is the primary pediatric teaching hospital of Harvard Medical School, where our physicians hold faculty appointments. We’re the largest pediatric orthopedic center in the nation, with 13 specialty clinics; an onsite brace shop; a plaster room; and a clinical team of orthopedic surgeons, orthopedic residents and fellows, certified physician assistants, nurse practitioners, registered nurses, physical/occupational therapists, brace technicians and cast technicians.