What is Clubfoot?

Clubfoot is a birth defect that causes 1 or both of a baby’s feet to turn inward, or to point upward. This occurs because the tendons that connect the leg muscles to the foot are short and tight, causing the foot to twist and bear a rough resemblance to a golf club. Clubfoot effects 1 out of every 1,000 babies in the U.S. making it one of the most common congenital foot deformities. It’s not usually a painful condition, but it needs to be treated early so your child can walk normally later.

What Are the Different Types of Clubfoot?

There are 2 types of clubfoot: isolated (or idiopathic) and non-isolated.

If your child has isolated clubfoot it usually means they do not have other related medical conditions. This is the most common and easily treated type of clubfoot.

If your child has other medical conditions—like arthrogryposis or spina bifida—then their clubfoot is called non-isolated clubfoot. This type can be more challenging to treat.

Services Provided at LuskinOIC Center for Clubfoot

At the Center for Clubfoot, our renowned specialists and team of cast technicians, orthotists and physical therapists will be there to help you and your child with a full range of treatment and support services, including:

• Onsite diagnostic imaging, such as X-rays
• Clubfoot treatment customized to your child
• Guidance, care and support during and after each phase of treatment
• Surgery, if necessary

Diagnosis

Most of the time, clubfoot can be detected before a child is born with a prenatal ultrasound. The diagnosis can be confirmed afterbirth with a physician exam. In rare cases, your doctor may request X-rays to determine the severity of your child’s clubfoot.

 Treatment: The Ponseti Method

At LuskinOIC, our preferred treatment is a 3-stage process called the Ponseti method. Treatment usually starts in the first 2 weeks after birth. We’ve also achieved excellent results treating children referred to us at an older age.

The goals of clubfoot treatment are to make the foot (or feet):

• Functional
• Flexible
• Painless
• Positioned so that the child can stand and walk normally

The Three Stages of the Ponseti Method

Stage 1: Stretching and Casting

Timeline: 4 to 6 weeks

During this first stage of treatment, an LuskinOIC clubfoot specialist will gently manipulate your baby’s foot through stretching into the right position. A long-leg cast that spans from the toes to the thigh will be applied to hold your baby’s foot in place.

This step will be repeated weekly for 4 to 6 weeks. Once the foot is in the proper position, the treatment moves into Stage 2.

Stage 2: Achilles Tenotomy

Timeline: 3 weeks

Next is a quick, minor medical procedure called an Achilles tenotomy. Your baby’s surgeon will make a tiny cut in the Achilles tendon (the cord behind the heel), which will allow the tendon to lengthen and be more flexible as it grows back. Because it is such a small incision, your child won’t need stitches.

After the procedure, your baby will receive a new cast. The cast will be removed when the tendon has healed at the right length and the foot is completely corrected.

Stage 3: Bracing

Timeline: 3 to 5 years

Once Stage 2 is complete, your child will need to wear a brace for a few years to keep the clubfoot from recurring. This brace is sometimes called the “boots and bar” brace because it’s made of 2 shoes connected by a metal bar. Some bars allow each leg to move on its own, while others only allow both feet to move together. The brace may look uncomfortable, but should not hurt or bother your child. Your child will learn how to crawl, sit and walk with the brace on, just like other kids their age.

The brace is usually worn for 23 hours each day for the first 3 months. After that, your child might have to wear it during naptime and overnight (about 12 to 14 hours a day) for 3 to 5 years.

Read tips about adjusting to and managing the brace years.

Stretching Exercises for Clubfoot

Your child’s doctor may recommend stretching exercises to help improve flexibility and strengthen your child’s clubfoot. If they believe additional strengthening is needed, your child may be referred to physical therapy.

Exercises may include:

• Ankle Dorsiflexion Exercises: Place the palm of your hand under your child’s foot and put the other hand on your child’s flexed knee. Gently flex the ankle up and out. Hold this position for 10 seconds and repeat 10 times.
• Ankle Eversion Exercises: Place a hand around the calf of your child’s leg and the other hand around the base of the great toe. Gently, bring the foot outward. Hold this position for 10 seconds and repeat 10 times.

Life After Clubfoot Treatment

The clubfoot treatment process can be intense. It requires extensive time and effort, especially during the bracing stage. But eventually, your child will reach the end of treatment.

Our goal with every child is for them to walk, run and play just like any other kid. Your child will be able to wear regular shoes and walk normally after successful treatment. Keep in mind, if the clubfoot affected only 1 foot, that foot might be 1 to 1½ shoe sizes smaller than the other. You’ll need to keep getting correct measurements of your child’s feet as they grow and make sure they’re wearing the right shoe size on each foot.

If only 1 foot has clubfoot, you’ll notice the muscles in the leg of the affected foot are underdeveloped and therefore your child’s calf might look smaller. In some cases, the leg is slightly shorter, as well. However, this rarely impacts a child’s ability to walk and play like other kids.

Can My Child’s Clubfoot Come Back after Treatment?

Unfortunately, yes. Even after treatment, clubfoot has a strong tendency to recur until your child is about 5 to 7 years old.

That’s why consistent bracing is so important: It can help prevent relapses. In fact, it’s much less common for a relapse to occur when the brace is applied properly and used for the length of time recommended by the doctor who is overseeing a child’s treatment.

Warning signs of relapse can be hard to spot if you don’t know what to look for. For instance, talk to your child’s doctor at LuskinOIC right away if:

• Your child puts more weight on the outside part of the sole of the foot when walking
• Your child’s foot is routinely slipping out of the bracing boot
• Your child’s heel turns inward or outward

The longer your child wears the brace as directed, the lower the chances of relapse. In fact:

• 90% of clubfoot cases relapse if bracing is stopped in the first year
• By the fourth year of bracing, the relapse rate drops to 10% to 15%
• After that, only about 6% of clubfoot cases relapse

If your baby has clubfoot, our experts at LuskinOIC’s Center for Clubfoot can explain the best options for care and will be there for you and your child throughout treatment and beyond.

Clubfoot Resources

Ponseti International Association

Clubfoot Cares

• Facebook Page
• Mission: Clubfoot C.A.R.E.S is a U.S.-based advocacy group dedicated to promoting public awareness of clubfoot and The Ponseti Method, as well as educating and empowering patients and their families.

Clubfoot Support

• Facebook Page
• Public group: anyone can see who’s in the group and what they post
• Visible: Anyone can find this group
• Members: 7,500+

Clubfoot Connection

• Facebook Page
• Private: Only members can see who’s in the group and what they post
• Visible: Anyone can find this group
• Members: 7,500+

Clubfoot is Treatable

• Facebook Page
• Private: Only members can see who’s in the group and what they post
• Visible: Anyone can find this group
• Members: 5,000+

Clubfoot Research Forum/Foundation

• Facebook Page
• Private: Only members can see who’s in the group and what they post
• Visible: Anyone can find this group
• Members: 4,500+

Clubfoot Community of California

• Facebook Page
• Private: Only members can see who’s in the group and what they post
• Visible: Anyone can find this group
• Members: 1,00+

Clubfoot Mommas and Daddies

• Facebook Page
• Private: Only members can see who’s in the group and what they post
• Visible: Anyone can find this group
• Members: 2,500+

Clubbed Foot Support Group

• Facebook Page
• Private: Only members can see who’s in the group and what they post
• Visible: Anyone can find this group
• Members: 5,500+

Parents Guide to Successful Bracing for Clubfoot

Practical advice for parents on using a foot abduction brace following correction of clubfoot using the Ponseti Method.