KidsMD Health Topics

Our Health Topics

Cleft Foot

  • "Our chief surgical goals with cleft foot are to close the cleft and to optimize the foot's function and appearance. At Children's, we take an individualized approach to each child's limb difference or congenital difference - including for this extremely rare condition - because no two cases are alike."

    --Samantha Spencer, MD, orthopedic surgeon, Boston Children's Hospital

    At Boston Children's Hospital, we understand your concern if your baby was born with a cleft foot. Our Orthopedic Center will approach your child’s condition with care and support—for your child and your whole family.

    • A diagnosis of cleft foot means that your child’s foot has a deepened space that extends toward the ankle; there may be missing toes or other anatomical anomalies.
    • Clefts are usually V-shaped.
    • The condition is present and visible at birth (congenital).
    • There’s a clear genetic basis for a typical cleft foot—the condition is commonly thought to be inherited.

    Cleft foot can occur:

    • by itself (in isolation)
    • along with a similar cleft of the hand (called split hand-split foot malformation, [SHFM] or ectrodactyly)
    • as part of a genetic syndrome
    • The condition in isolation is extremely rare, and is estimated to affect fewer than 1 in 1,000,000 babies.
    • Most affected children—except those with very mild cases—need one or more surgeries, usually starting at around 1 or 2 years of age, when a child can tolerate surgery and anesthesia well.
    • Surgery’s first goal is to improve the foot’s function.
    • The second goal is to improve the foot’s shape and appearance, preferably before the child becomes aware that her foot looks different from those of other children.
    • Surgically re-shaping the foot increases the chances of the child being able to wear off-the-shelf shoes, instead of costly custom-made shoes.
    • When planning surgery, the surgeon must consider not just the bones of the foot, but also soft tissue, such as ligaments and nerves.

    How Boston Children's Hospital approaches cleft foot
    The Orthopedic Center's Lower Extremity Program offers comprehensive assessment, diagnosis, surgical and non-surgical treatment of infants, children and teens with complex disorders of the lower extremities, including cleft foot.

    With more than 5,000 pediatric visits per year, our multidisciplinary team of fellowship-trained, board-certified, pediatric orthopedic surgeons is one of the most experienced in the country.

    Our Orthopedic Center—one of the first of its kind in the nation—is internationally known as a premier center for the orthopedic care of infants, children and young adults. You can have peace of mind knowing that our skilled experts have treated thousands of babies and children with cleft foot and other upper and lower limb problems. We provide expert diagnosis, treatment and care, and our patients benefit from Children’s advanced clinical and scientific research.

    Cleft foot: Reviewed by 

    Samantha Spencer, MD

    © Boston Children's Hospital, 2011

    Contact Us

    Orthopedic Center

    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • At Boston Children's Hospital, 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 Boston 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
  • At Boston Children's Hospital, we understand that the first step to treating your child is obtaining an accurate, timely and thorough diagnosis.

    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, her doctor will check for other associated deformities or syndromes.

  • At Boston Children's Hospital, experts in our Orthopedic Center  provide comprehensive care—including evaluation, diagnosis, consultation, surgery, non-surgical therapies and follow-up care.

    Whether to do surgery

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

    When to do 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.

    Goals of surgery

    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, her 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 her foot, during which time her doctor will monitor her progress monthly. The doctor will then follow her yearly until she stops growing (reaches skeletal maturity).

    Long-term outlook

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

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

    Coping and support

    At Boston Children's Hospital, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:

    • getting to Boston Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family

    In particular, we understand that you may have a lot of questions when your child is diagnosed with cleft foot. Will this affect my child long term? Will she be able to enjoy regular activities? Boston Children's can connect you with extensive resources to help you and your family through this stressful time, including:

    • patient education: From doctor's appointments to physical therapy and recovery, our nurses and physical therapists will be on hand to walk you through your child's treatment and help answer any questions you may have—Why will my child need surgery? Are there non-surgical options? How long will her recovery take? How should we manage home exercises and physical therapy? We'll help you coordinate and continue the care and support your child received while at Boston Children's. 
    • parent-to-parent: Want to talk with someone whose child has been treated for cleft foot? We can often put you in touch with other families who've been through the same process that you and your child are facing, and who will share their experiences. 
    • faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children'schaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience. 
    • social work: Our social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.
  • Improving outcomes for lower extremity disorders

    The Orthopedic Center's Lower Extremity Program is dedicated to the comprehensive care of all lower limb conditions in infants, children and teens. Patients with congenital, neuromuscular, sports-related, oncologic and traumatic or post-traumatic conditions of the lower extremity receive multi-disciplinary care that includes occupational and physical therapy, splinting/casting and reconstructive surgery.

    The Program is committed to improving clinical care through continued clinical and basic science research. Many of our investigations have resulted in national and international presentations or peer-reviewed medical publications—and all have increased our ability to provide the highest standard of care.

    Children speak about what it’s like to be a medical research subject

    View a video of a day in the life of Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science.

Request an Appointment

If this is a medical emergency, please dial 9-1-1. This form should not be used in an emergency.

Patient Information
Date of Birth:
Contact Information
Appointment Details
Send RequestIf you do not see the specialty you are looking for, please call us at: 617-355-6000.International visitors should call International Health Services at +1-617-355-5209.
Please complete all required fields

This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

Thank you.

Your request has been successfully submitted

You will be contacted within 1 business day.

If you have questions or would like more information, please call:

617-355-6000 +1-617-355-6000
close
Find a Doctor
Search by Clinician's Last Name or Specialty:
Select by Location:
Search by First Letter of Clinician's Last Name: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
More optionsSearch
Condition & Treatments
Search for a Condition or Treatment:
Show Items Starting With: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
View allSearch
Visitor Information

Contact the Orthopedic Center

  • 1-617-355-6021
  • International: +01-617-355-5209
  • Locations
The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
Close