Care for Congenital Foot Deformities

What Parents Need to Know

Understanding clubfoot, its signs, and why early treatment matters for your child.

Understanding Clubfoot in Infants

Clubfoot can be several foot abnormalities that are congenital, or present at birth. The tendons in the baby’s foot are shorter and so the foot is out of position or twisted. It is one of the most common congenital deformities, occurring in about 1 out of every 1000 births. It can affect one or both feet, and the foot shape at birth is pointed inward and downward, giving the foot a club appearance.

Parents should look for one or more of these signs: the top of the foot is twisted inward and downward, the foot appears to be upside down, the foot or leg may be shorter, and the calf muscles are underdeveloped. Usually there will be no pain associated with the deformity.

The cause in an otherwise healthy child is unknown. Boys are more likely to have clubfoot than girls, and it tends to run in families. The baby may have clubfoot if there is too little amniotic fluid, and the risk of clubfoot is greatly increased if the mother smokes during pregnancy.

Without treatment, clubfoot can result in complications in later life such as arthritis, poor self-image, inability to walk correctly, and foot sores or calluses. Treatment should begin within 1 to 2 weeks after birth, when the baby’s joints, bones, and tendons are still flexible, so an early evaluation is the best first step.

The Ponseti Method and Prevention

Dr. Brianna David, who has taken over her father’s (Dr. Michael David) clubfoot practice, utilizes the Ponseti Method of serial casting of the foot and leg. This treatment has become the standard of care nationwide. The foot is gently manipulated and plaster casts are applied and changed weekly for 3 to 6 weeks in the office without anesthesia. Correction can be achieved in over 90% of cases without the need for extensive surgery.

Occasionally a release of the heel cord is needed. This is performed in the office through a tiny incision without the need for anesthesia or hospitalization. Relapses are uncommon and are corrected successfully in most cases with 1 to 3 more casts. Special shoes attached to a bar are used 20 to 22 hours per day for 3 months, followed by use during sleep hours for 2 to 4 years.

In many institutions, manipulation and casting technique is used with frequent unsuccessful correction. As a result, extensive corrective surgery is then recommended with often disturbing poor results due to excessive scarring. Dr. Brianna David has frequently used the Ponseti Method successfully in older children who have had failed treatment from other institutions.

In pregnancy, you can take steps to reduce the risk of your baby having birth defects: don’t smoke, avoid smoky environments, don’t drink alcohol, and don’t take drugs except those approved by your doctor. With early treatment and proper bracing, most children with clubfoot go on to walk, run, and play normally.