Cleft Foot | Diagnosis & Treatment

How is cleft foot diagnosed?

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 your child’s foot, determining what is present or absent, normal or abnormal. The doctor will carefully assess the specifics of the soft tissue of your child’s foot, including ligaments, blood vessels, nerves and muscles.

If your child is diagnosed with a cleft foot, their doctor will check for other associated deformities or syndromes.

How is cleft foot treated?

Not all children need surgery for a cleft foot—it may not be necessary if your child has good use of their foot and the deformity is not too severe. However, if your child's foot has significant functional or cosmetic problems, their doctor may recommend surgery.

Surgeons will perform surgery early in a child's life if the cleft foot's deformities are progressive (will worsen over time)—such as syndactyly (joining) between the toes, or transverse bones between the digits. If the cleft foot doesn't have progressive deformities, surgery can take place when the child is 1 or 2 years old.

If surgery is needed to repair a cleft foot, surgeons have many different approaches available. The timing and sequence of procedures will vary from child to child, but in general, the first procedure is usually done when, or after, a child is 1 or 2 years old—old enough to tolerate anesthesia and surgery well.

In general, the goals of surgery are:

   •   close the cleft and make sure your child can use his foot effectively
   •   reorganize the skin and soft tissue
   •   stabilize or transfer the bones of the foot

Caring for your child after surgery and into childhood

For about four to six weeks after surgery, your baby will be in a cast stabilized by pins. After this period, the doctor can remove the cast and pins in the office setting without sedation.

For several weeks, your child will wear a splint to bed to maintain alignment and help with scar reduction. She'll receive occupational therapy until she achieves supple active motion and developmentally appropriate use of their foot, during which time the doctor will monitor their progress monthly. The doctor will then follow them yearly until they stops growing (reaches skeletal maturity).

What is the long-term outlook?

The quality of the reconstruction of your child's foot depends to a large extent on how severe the original malformation was. As a result of surgery, you can expect that she will have a functional foot and an improvement in the foot's appearance. The alignment of the toes should also improve.

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