Clubfoot is when the foot turns inward and downward. It is a congenital condition, which means it is present at birth.
Talipes equinovarus; Talipes
Causes, incidence, and risk factors
Clubfoot is the most common congenital disorder of the legs. It can range from mild and flexible to severe and rigid.
The cause is not known, but the condition may be passed down through families in some cases. Risk factors include a family history of the disorder and being male. The condition occurs in about 1 out of every 1,000 live births.
The physical appearance of the foot may vary. One or both feet may be affected.
The foot turns inward and downward at birth, and is difficult to place in the correct position. The calf muscle and foot may be slightly smaller than normal.
Signs and tests
The disorder is identified during a physical examination. A foot x-ray may be done.
Treatment may involve moving the foot into the correct position and using a cast to keep it there. This is often done by an orthopedic specialist. Treatment should be started as early as possible -- ideally, shortly after birth -- when it is easiest to reshape the foot.
Gentle stretching and recasting will be done every week to improve the position of the foot. Generally, five to 10 casts are needed. The final cast will stay in place for 3 weeks. After the foot is in the correct position, the child will wear a special brace nearly full time for 3 months. Then, the child will wear the brace at night and during naps for up to 3 years.
Often, the problem is a tightened Achilles tendon, and a simple procedure is needed to release it.
Some severe cases of clubfoot will need surgery if other treatments do not work, or if the problem returns. The child should be monitored by a health care provider until the foot is fully grown. See: Clubfoot repair
The outcome is usually good with treatment.
Some defects may not be completely fixed. However, treatment can improve the appearance and function of the foot. Treatment may be less successful if the clubfoot is linked to other birth disorders.
Calling your health care provider
If your child is being treated for clubfoot, call your health care provider if:
The toes swell, bleed, or change color under the cast
The cast appears to be causing significant pain
The toes disappear into the cast
The cast slides off
The foot begins to turn in again after treatment
Hosalkar HS, Spiegel DA, Davidson RS. The foot and toes. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 673.
John Goldenring, MD, MPH, JD, Pediatrician with the Sharp Rees-Stealy Medical Group, San Diego, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.