Clubfoot

You know immediately if your newborn has clubfoot. One of the most common nonmajor birth defects, clubfoot affects a child's foot and ankle, twisting the heel and toes inward. The clubfoot, calf and leg are smaller and shorter than normal. Clubfoot is not painful, the deformity is correctable, and your baby is probably otherwise normal. Approximately one in every 1,000 newborns has clubfoot. Of those, one in three have both feet clubbed. No one knows why it happens, but babies have been born with clubfoot for many hundreds of years. Two out of three clubfoot babies are boys. Clubfoot is twice as likely if you, your spouse or your other children also have it. Less severe infant foot problems are also common and are sometimes mislabeled as clubfoot.

Stretching and Casting

Treatment begins right away. The goal is to make your newborn's clubfoot (or feet) functional, painless and stable by the time he or she is ready to walk. Doctors start by gently stretching your child's clubfoot toward the correct position. They put on a cast to hold it in place. One week later, they take off the cast and stretch your baby's foot a little more, always working it toward the correct position. They apply a new cast, and one week later you come back and do it again. This process (serial casting) slowly moves the bones in the clubfoot into proper alignment. Doctors use X-rays to check the progress. Casting generally repeats for 6 to 12 weeks, and may take up to four months. (Note: Anytime your baby wears a cast, watch for changes in skin color or temperature that may indicate problems with circulation.)
 

About half the time, your child's clubfoot straightens with casting. If it does, he or she will be fitted with special shoes or braces to keep the foot straight once corrected. These holding devices are usually needed until your child has been walking for up to a year or more. Muscles often try to return to the clubfoot position. This is common when your child is 2 to 3 years old, but may continue up to age 7. 

Surgery

Sometimes stretching, casting and bracing are not enough to correct your baby's clubfoot. He or she may need surgery to adjust the tendons, ligaments and joints in the foot and ankle. This is usually done when your child is 6 to 12 months old. Surgery corrects all of your baby's clubfoot deformities at the same time. After surgery, another cast holds the clubfoot together while it heals. It's still possible for the muscles in your child's foot to try to return to the clubfoot position and special shoes or braces will likely be used for up to a year or more after surgery. It's possible that your baby will not need another operation as the child grows.
 

If your child's clubfoot is not treated, he or she will have a severe functioning disability. With treatment, your child should have a nearly normal foot. He or she can usually run and play without pain, and can wear normal shoes. The corrected clubfoot will still not be perfect, however. You should expect it to stay 1 to 1- 1/2 sizes smaller and somewhat less mobile than the normal foot. The calf muscles in your child's clubfoot leg will also stay smaller.

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This material was codeveloped by the American Academy of Orthopaedic Surgeons.

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