Clubfoot

What is clubfoot?

Clubfoot is a congenital foot deformity that affects a child’s bones, muscles, tendons, and blood vessels. The front half of an affected foot turns inward and the heel points down. In severe cases, the foot is turned so far that the bottom faces sideways or up rather than down. The condition, also known as talipes equinovarus, is fairly common. About one to four of every 1,000 babies are born with clubfoot. The condition affects boys twice as often as it does girls.

With clubfoot, the front half an affected foot turns inward and the heel points down. 

About 50 percent of children with clubfoot have it in both feet, a condition known as bilateral clubfoot. Many parents find out their child has clubfoot during a prenatal ultrasound months or weeks before their child is born. Once the child is born, the condition is clearly visible. Ideally, treatment begins in the first month of a child’s life.

Despite the appearance, clubfoot is not a painful condition for babies. Almost all children who receive early treatment are able to run, play, and function quite normally. Without treatment, clubfeet do not get better on their own. The foot remains in the deformed position and makes it hard for a child to walk.

What are the symptoms of clubfoot?

Clubfoot is readily visible when a baby is born.

  • The front half of the foot turns inward and the heel points downward.

If only one foot is affected:

  • The calf muscle on the affected leg is smaller than on the other leg.
  • The leg on the affected side is often shorter than on the other side.
  • The affected foot may be short and wide.

Who’s at risk for developing clubfoot?

Most children with clubfoot do not have a parent with the condition. However, having an older sibling with clubfoot increases a baby’s risk of being born with the condition.

  • If a boy has a clubfoot, there’s a 2.5 percent chance that his next-born sibling will have clubfoot, too.
  • If a girl has a clubfoot, there’s a 6.5 percent chance that her next-born sibling will be born with clubfoot.

Other risk factors include:

Babies born with clubfoot 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.

Diagnosed with clubfeet before he was born

If she could go back in time, Cheryl would reassure herself about her baby’s clubfeet. “It’s part of how he is as a baby. We don’t expect it to cause any long-term difficulties.”

Gabriel is shown at 3 weeks old, after his first correction.

What causes clubfoot?

Most clubfeet are “idiopathic,” meaning that doctors don’t know for sure what causes them. Clubfoot probably has a genetic component and runs in families. But researchers don’t yet know what gene (or set of genes) is responsible.

In all children with clubfeet, tightness of the muscles and tendons around the foot and ankle keep the foot in the characteristic downward and inward position. This tightness may be related to differences in blood circulation or how nerves receive signals in the affected legs. Other theories for the causes of clubfeet include defects in development of the bones, tendons, or muscles or some mechanical obstruction in utero. However, these theories have not yet been proven.

In some cases, clubfoot is part of a syndrome or birth defect. In other cases, the foot was in an awkward position in the mother’s womb. But most of the time, children are born with clubfoot for no known reason.

What are the different types of clubfoot?

There are two types of clubfoot, each with different causes.

Idiopathic clubfoot

The most common type of clubfoot is idiopathic, which means the cause is unknown. Idiopathic clubfoot is not related to any other medical problems. Feet of babies with this type of clubfoot are stiff and hard to manipulate.

Syndromic clubfoot

Syndromic clubfoot occurs when the condition is part of a larger syndrome. This type is usually more severe and difficult to treat.

How we care for clubfoot at Boston Children’s Hospital

The Lower Extremity Program at Boston Children's Hospital takes a conservative, non-surgical approach to clubfoot whenever possible, and we have excellent success rates. In the rare case that a newborn needs surgery, we work with the Department of Anesthesiology, Critical Care and Pain Medicine to avoid the use of general anesthesia whenever we can.

We offer an especially strong and supportive bracing program. We also work with the Maternal Fetal Care Center, the hospital’s prenatal counseling program, to help parents anticipate and plan for their baby’s care after birth.