Club Foot

The symptoms of club foot vary but are very easy to identify by a medical professional. Club foot could be difficult to spot if you are a first-time parent and if this condition is not severe. Symptoms of club foot include:

• A foot that turns inward and downwards, with toes pointing towards the opposite foot.
• The heel on the club foot may be twisted upside down.
• The club foot may be smaller than the other foot.
• In most severe cases, the club foot may be twisted upside down.
• The calf muscle on the affected leg with the club foot will be slightly smaller.

Most doctors aren’t quite sure what causes club foot. There is some evidence to suggest that there is a genetic link, this means it seems to run in families. Also, if you already have a child born with a club foot, your next child has a greater risk of also developing club foot as well.

There is also research to suggest that club foot is much more common in babies whose mothers smoked or used recreational drugs during pregnancy. This is especially true if there is already a family history of club foot. Additionally, there could be a link between low amniotic fluid and club foot. Amniotic fluid is the liquid that surrounds a baby in the womb.

If you are pregnant and have a family history of club foot, you may want to meet with a genetic counselor. He / she will be able to tell you more about the chances that your baby will have a club foot.

Generally, boys are twice as likely to develop club foot rather than girls. Other risk factors of club foot include:

• Congenital conditions – In some cases, club foot can be associated with other abnormalities of the skeleton that are present at birth, such as spina bifida, a birth defect that occurs when the spine and spinal cord do not develop or close properly.

• Family history – If either one of the parents or their other children have had a club foot, the baby is more likely to have it as well.

• Environment – Smoking during pregnancy can significantly increase the baby’s risk of club foot.

• Not enough amniotic fluid – Too little of the fluid that surrounds the baby in the womb may increase the risk of club foot.

• Genetics – Genes can tell the body how to look, grow, and function. A problem with one or more genes could result in club foot.

A woman may be at a higher risk for having a baby with club foot if she:

• Had a condition known as oligohydramnios during pregnancy. This is a problem of not having enough amniotic fluid.
• Had Zika infection during pregnancy, which may lead to birth defects and other problems.
• Smoked, drank an excessive amount of alcohol, or used illegal drugs during pregnancy.

Club foot typically does not cause any problems until your child starts to stand and walk. If the club foot is treated, your child will most likely walk normally. However, he or she will likely have some difficulty with the following:

• Leg length – The affected leg may be slightly shorter, but generally does not cause significant problems with mobility.
• Movement – The affected boot may be slightly less flexible.
• Shoe size – The affected foot may be up to 1 1/2 shoe sizes smaller than the other foot.
• Calf size – The muscles of the calf on the affected side may always be smaller than those on the other side.

However, if left untreated, club foot causes more serious problems. These can include the following:

• Arthritis – Your child is prone to develop arthritis.
• Inability to walk normally – The twist of the ankle may not allow your child to walk on the sole of the foot. To compensate, he or she may walk on the ball of the foot, the outside of the foot, or even the top of the foot in severe cases.
• Problems stemming from walking adjustments – Walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the foot, and result in an awkward gait.
• Poor self-image – The appearance of the foot can make your child’s body image a concern during the teen years.

In some cases, it is sometimes possible to walk with club foot, however, it is very difficult. Children who have club feet tend to walk on the sides of their feet. This can cause large callouses and chronic pain. As your child gets older, having an uncorrected club foot will mean having a less active lifestyle.

In most cases, club foot is diagnosed after your baby is born. Your doctor will be able to identify a club foot based on the appearance of your baby’s foot. Sometimes after a visual inspection of the foot, they may also order an X-ray to confirm the diagnosis.

Club foot can also be discovered in utero during an ultrasound. An ultrasound is a type of imaging used to look at babies in the womb. It is routine for a woman to have an ultrasound during her pregnancy to confirm her baby’s growth and development.

Even if club foot is discovered in utero, there is nothing that can be done to correct it until after the baby is born. In some cases, your baby will likely need a team of providers to treat club foot, including:

• Pediatric orthopedist – who specializes in bone and joint problems in children.

• Orthopedic surgeon – who specializes in surgery for bones and joints.

• Physiotherapist – to help the child build strength and move the foot.

There are several other methods for treating club foot – a care team will first discuss the options with you and figure out which works best for your child. Treatments include the following:

• Ponseti Method – stretches and casts the leg to correct the curve.
• Bracing – using special shoes to keep the foot at the proper angle.
• Surgery – this may be an option if other methods do not work.

The Ponseti Method is the most popular treatment method involving serial casting. It lasts about two to three months. Your care team will begin this therapy within the first two weeks after birth. An orthopedic surgeon performs this method. Firstly, they will stretch the foot toward the correct position.

Secondly, they put the foot in a cast, which starts at the toes and goes all the way to the upper thigh. Finally, they’ll repeat this process every four to seven days with a new cast. Each time, the surgeon moves the foot a little closer to the correct position.

Before the final cast, the surgeon typically performs an Achilles tenotomy; they cut the heel cord (Achilles tendon) in a quick procedure. This tendon connects the heel to the calf muscles – the cut is small and won’t need stitches. Lastly, they put on a new cast as the tendon heals, which takes about three weeks. The goal of this surgery is to allow the tendon to grow to a typical length. When the last cast comes off, the tendon has reached a regular length.

As your baby recovers, they may need to do stretching exercises so the feet stay in the correct position. Additionally, wearing special shoes or a foot brace will speed up the recovery process.

Your care team may also recommend bracing after your baby has finished the Ponseti treatment method. Even if those treatments worked, the foot can move back to the incorrect position. A brace keeps the foot at the correct angle, so it does not move out of position. The brace is normally a pair of shoes with a metal bar connecting them. The brace is often called boots and bar.

There are several types of braces. Your doctor will discuss the options with you so you can find the right brace for your child. Sometimes, when a child has a severe club foot, or you have tried non-surgical methods and they have not worked, then surgery can correct the problem. It is best if your child has the surgery before they start walking. During the procedure, the surgeon first:

• Lengthens the heel cord and fixes other problems with the foot or feet.
• Places pins in the foot to correct the position.
• Puts a cast on the foot after the surgery.

A few weeks after the surgery, the surgeon removes the cast / pins, then puts a new cast on the child’s foot, which your child wears for another four weeks. Finally, the surgeon will remove the final cast from the child.

There is still a chance the foot could return to the club foot position – your doctor may recommend bracing or special shoes to help keep the foot in the correct position.

Non-surgical treatments such as splinting are usually tried first. The foot is moved into the most normal position possible and immobilized in that position until the next treatment.

This manipulation and immobilization procedure is repeated every 1-2 weeks for 2-4 months, moving the foot a little closer toward a normal position each time. Some children have enough improvement that the only further treatment is to keep the foot in the corrected position by splinting as it grows.

Overall, a mild recurrence of club foot is common, even after successful treatment. Also, the affected foot will continue to be somewhat smaller and stiffer than the unaffected foot, and the calf of the leg will be smaller. Fortunately, after treatment, most children are able to wear shoes comfortably and therefore able to walk, run, and play.