A baby that is born with a foot that turns in and down has a clubfoot. The foot remains tight in that position and resists efforts to position it more normally.
There may be creases above the heel and in the middle bottom portion of the foot. The bones are abnormally shaped and the tendons, muscles and ligaments are tight. The foot and calf are usually smaller than normal. The muscles may be weaker and the nerves abnormal. Often the blood supply is abnormal as well.
Not all clubfeet are the same. Some are flexible, while others are stiff. There are degrees of deformities ranging from mild to severe. In the infant, a clubfoot is not painful.
It isn't yet known why some babies are born with a clubfoot. It may be a result of abnormalities of nerves, muscles or the blood supply to the foot during the development of the fetus. It usually is not due to anything a woman does or fails to do during her pregnancy.
Clubfoot is usually diagnosed at birth, but may sometimes be discovered during pregnancy.
Without treatment, a clubfoot doesn't improve. In fact, the deformity tends to get worse. The deformity becomes unsightly and crippling. Children can end up walking on top of their foot rather than on the bottom of the foot. This causes the skin to break down and sores and infections to develop. In the end, amputation may be needed.
To avoid amputation, treatment should begin as soon as possible after birth. This usually involves positioning the foot as normally as possible and putting it in a long leg cast to hold it in that position as it grows. Other treatments such as physical therapy, splints, taping or short leg casts may be used instead.
Typically, the positioning and casting are done once a week (sometimes biweekly) for six to eight weeks until maximum correction is obtained. The entire casting process may take as long as three months. Frequently, a brace is worn after the casting is done.
Whether the casting was successful is known when the child is three to six months old. If not, surgery to correct the clubfoot is usually done between the ages of six to nine months. This allows the correction to be done by the time the child is ready to start standing and walking.
