Clubfoot occurs when a foot and ankle are permanently twisted. In clubfoot, the ligaments and tendons that hold the muscles to the bones are too tight. This causes the tissues around the ankle to hold the foot in an abnormal position. Clubfoot resembles the head of a golf club, which is how it got its name.
Clubfoot is a congenital deformity, which means you’re born with the condition. Doctors usually diagnose it immediately after birth. It's important to diagnose it as soon after birth as possible and start treatment. If you get treatment early, it’s more likely to be an easier and successful.
The causes of clubfoot are unclear, but the risks of being born with it are higher if:
- you’re male
- your mother smoked during pregnancy
- someone else in your family has clubfoot
- you have spina bifida or other spinal cord injuries
Clubfoot can be repaired by casting or surgery.
Sometimes nonsurgical treatments, such as casting, can correct clubfoot. Casting is a method for correcting clubfoot in the hopes of avoiding surgery.
The Ponseti method is the most common technique used. In this treatment, your doctor gently stretches your foot into a more normal position and secures it with a cast. Every few days or weeks, the foot’s position is stretched even more towards a normal position and the cast is replaced.
Over the course of six to eight weeks, clubfoot may be corrected without surgery. Casting is more successful for those with mild clubfoot and those treated within the first two weeks of birth.
Babies and older patients who have severe clubfoot may not respond to casting. They need surgery to correct the condition.
During surgery, your surgeon lengthens the Achilles tendon near the heel and releases tissues elsewhere in the foot. They may also need to do a tendon transfer. These incisions loosen the tight ligaments and tendons so that your surgeon can then manipulate your foot into a normal position. A tendon transfer allows the foot to move in a more normal manner.
Older children and adults are often less flexible than babies and may require more extensive repair. It may require several surgeries. Your surgeon might need to cut into the bone to turn the foot. Cutting into the bone is called an osteotomy. In these cases, metal plates or screws may be used to hold the foot in the correct position. Once your foot and ankle are securely placed, your surgeon puts your leg in a cast.
Clubfoot repair is performed under a general anesthetic. You’re asleep and don’t feel pain during the procedure. Medication will help you manage the pain after surgery.
Clubfoot patients remain in the hospital for up to three days after surgery. The casted leg stays elevated to reduce swelling. Your child may be asked to wiggle their toes to make sure blood flow to their foot isn’t interrupted.
Casting is an important part of the recovery process. You’ll wear a cast for as long as three months to allow the incisions, tendons, and bones to heal. The cast may need to be replaced several times, especially for infants and toddlers who grow quickly. After the cast is removed, the foot should look more like a normal foot and function better.
Physical therapy plays a crucial role in the success of clubfoot surgery. Foot exercises help restore flexibility, range of motion, and muscle tone to the leg. Many people who have clubfoot have underdeveloped calf muscles in the affected leg. Even after surgery, the muscles may remain permanently smaller than in the healthy leg.
Some people must wear a brace after clubfoot surgery. The brace helps keep the foot in a more normal position and assists with normal movement.
Children who undergo clubfoot repair surgery can lead active lives with few risks. Potential risks associated with this surgery include:
- nerve damage in the foot
- excessive foot swelling
- an interrupted blood flow to the foot
- the formation of an ulcer from a cast that’s too tight
The most common complaint people have after clubfoot repair is stiffness in the foot and ankle. This can result in arthritis as people age. As children get older and grow, having the surgery again is sometimes necessary.