Clubfoot

What is clubfoot?

Clubfoot (also called talipes equinovarus) is a birth defect of the foot. It’s when a baby’s foot turns inward so that the bottom of the foot faces sideways or even up. This happens because the tissues that connect muscles to bone (called tendons) in your baby’s leg and foot are shorter than normal.

Clubfoot is a common birth defect. About 1 in 1,000 babies is born with clubfoot in the United States each year. About half of all babies with clubfoot have it in both feet. Birth defects are structural changes present at birth that can affect almost any part of the body. They may affect how the body looks, works or both. Birth defects can cause problems in overall health, how the body develops or how the body works.

There are two types of clubfoot:

1. Isolated clubfoot (also called idiopathic clubfoot). This is the most common type. It happens in children who have no other medical problems.
2. Nonisolated clubfoot. This type happens together with other health problems, like arthrogryposis or spina bifida. A baby with arthrogryposis is born with joint problems that make it hard for him to move his hands or legs. His joints may not move the right way or they may get stuck in one position. Spina bifida is the most common kind of neural tube defect (also called NTD). NTDs are birth defects of the brain, spine and spinal cord. Spina bifida can affect how a baby’s brain, spine, spinal cord and meninges develop. Meninges are the tissues that cover and protect the brain and the spinal cord.

What causes clubfoot?

We don’t know for sure what causes clubfoot. Clubfoot may be genetic. This means it can be passed from parents to children through genes. Genes are the parts of your body’s cells that store instructions for the way your body grows, looks and works.

Clubfoot also may be caused by things in your environment. Your environment is all the things you come in contact with that affect your everyday life, including things like where you live, where you work, the kinds of foods you eat and how you like to spend your time. Some things in your environment can be harmful to a pregnancy, like certain drugs and cigarette smoke.

Your baby may be at risk for clubfoot if:

• Your baby is a boy. Boys are twice as likely as girls to have clubfoot.
• You have a family history of clubfoot. This means that you, your partner or someone in your families has clubfoot. If you, your partner or your child has clubfoot, your baby’s risk of having clubfoot increases. If you already have a baby with clubfoot, your chance of having another baby with it is about 1 in 25 (about 4 percent).
• Your baby has another birth defect, like spina bifida or cerebral palsy (also called CP). CP is a group of conditions that affects the parts of the brain that control the muscles.
• Your baby has a genetic condition, like Trisomy 18 (also called Edwards syndrome). Babies with trisomy 18 may have birth defects and life-threatening health problems.
• You have oligohydramnios during pregnancy. This is when you don’t have enough amniotic fluid. This is the fluid that surrounds your baby in the womb.
• You have Zika infection during pregnancy. Zika is a virus that’s associated with congenital Zika syndrome (also called CZS). CZS includes birth defects (like clubfoot) and other health and development problems.
• You smoke (or are exposed to smoke), drink alcohol or use street drugs during pregnancy. If you smoke during pregnancy, your baby’s chances of having clubfoot may be twice that of babies born to women who don’t smoke. Secondhand smoke is smoke you breathe in from someone else’s cigarette, cigar or pipe.

What are the signs of clubfoot?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Signs of clubfoot include:

• One or both feet point down and turn in toward the other leg.
• The foot is turned and is shaped like a kidney.
• The foot has a deep crease on the bottom.
• The foot has a deeper arch than normal.
• The calf muscle is thin in one or both legs.
• The foot bones and ankle joints aren’t normal.

How do you know if your baby has clubfoot?

Sometimes your health care provider may see that your baby has clubfoot before birth on an ultrasound. Ultrasound is a prenatal test that uses sound waves and a computer screen to show a picture of your baby inside the womb. Even though clubfoot can’t be treated until your baby is born, knowing about it while you’re pregnant may help you plan for your baby’s treatment after birth.

After birth, your baby’s health care provider can find clubfoot and other foot problems during a physical exam. Your baby’s provider may use other tests, like a foot X-ray, to see if your baby has clubfoot. An X-ray is a medical test that uses radiation to make a picture of your baby’s body on film.

What problems does clubfoot cause for your baby?

Clubfoot can range from mild to serious. It isn’t painful, and it doesn’t bother your baby until he begins to stand and walk. Clubfoot needs treatment to get better. If not treated, your baby may have:

• Problems walking. For example, he may walk on the sides of his feet or even on the tops of his feet instead of on the bottoms or soles of the feet.
• Infections in the part of the foot he walks on
• Thick, hard skin and calluses on the foot. A callus is a thick, hard layer of skin often on the sole of the foot. It’s caused by repeated friction (rubbing) or pressure on the foot.
• Arthritis. This is a health condition that causes joint pain, aches, stiffness and swelling.

How is clubfoot treated?

Your baby may have a team of health care providers who treat clubfoot. The team may include:

• A pediatric orthopedist. This doctor treats bone and joint problems in babies and children. 
• An orthopedic surgeon. This is a doctor with special training do surgery on bones, muscles and joints.
• A physical therapist. This provider creates exercise programs to help build strength and help with movement.

Your baby’s provider can help you understand the best treatment for your baby. Until recently, many children with clubfoot had surgery to correct the condition. Now, most children with clubfoot can be treated without surgery.

Treatment works best when it’s started early, even as early as 1 week old. With early treatment, most children with clubfoot can grow up to wear regular shoes. They can have active lives and walk, run and play without pain.

Clubfoot treatment may include:

Stretching and casting (also called the Ponseti method). This is the most common treatment for clubfoot. It usually starts in the first 2 weeks of your baby’s life. For this treatment, an orthopedic surgeon gently stretches your baby’s foot toward the correct position and then puts it in a long cast. The cast goes from your baby’s toes to his upper thigh. Every 4 to 7 days, your baby’s surgeon takes off the cast, moves your baby’s foot closer to the correct position and puts on a new cast. Before your baby gets his last cast, his surgeon may cut the heel cord (also called the Achilles tendon). This is the tendon that connects the heel to muscles in your baby’s calf. Cutting the heel cord allows it to grow to a normal length by the time the last cast comes off. The cut is very small and does not require stitches. A new cast will be put on your baby’s leg to protect it as it heals.

This type of treatment usually fixes the problem in 2 to 3 months. When the last cast is taken off, the heel cord will have regrown to the right length. After that, your baby can do stretching exercises to help keep his feet in the right position. He also may need to wear special shoes or a brace at night for a few years.

Stretching, taping and splinting (also called the French method). With this treatment, a physical therapist stretches your baby’s foot toward the correct position and uses tape and splints to hold it that way. Splints are supports that are used to protect injured bones and tissues. This treatment usually starts soon after birth and is done every day for 2 months and then less often until your baby is 3 months old. Your baby gets treated by a therapist about three times each week. Your baby’s therapist teaches you how to do the treatment with your baby at home.

Bracing. Even after successful treatment with casting, your baby may need to wear a brace (also called an orthotic). This type of bracing usually includes special shoes connected by a metal bar. The brace keeps the foot at the proper angle to keep it from moving out of position. Your child may wear a brace for about 3 months, and then only at night or during naps for a few years. It’s important that your baby wears the braces every day. If he doesn’t, there’s a high chance that his foot returns to the clubfoot position again.

Surgery. If your baby’s clubfoot is severe or if stretching treatments don’t work, clubfoot can be treated with surgery. It’s best for your baby to have surgery before he starts walking. Surgery can help make the heel cord longer and fix other problems with the feet. Four to 6 weeks after surgery, the surgeon removes the pins and cast, and applies a short-leg cast, which your baby will wear for another 4 weeks. After the last cast is taken off, your baby’s muscles may still try to return to the clubfoot position, so your baby may need special shoes or braces.

How can you prevent clubfoot in your baby?

Because we’re not sure what causes clubfoot, it may not be possible to prevent all cases. But doing these things may help reduce your baby’s risk of having clubfoot:

Before pregnancy

• Get a preconception checkup. This is a medical checkup you get before pregnancy to make sure you’re healthy when you get pregnant.
• Talk to a genetic counselor if you have a family history of clubfoot. A genetic counselor is a person who is trained to know about genes, birth defects and other medical problems that run in families.
• Get checked for infections, like Zika. Early testing and treatment can help you have a healthy pregnancy and a healthy baby.

During pregnancy

• Go to all of your prenatal care checkups. Prenatal care is medical care during pregnancy. Getting early and regular prenatal care can help you have a healthy pregnancy. Go to all your prenatal care checkups, even if you’re feeling fine.
• Protect yourself from Zika. Don’t travel to Zika-affected areas (a place where Zika is spreading) unless you absolutely have to. Prevent mosquito bites. Don’t have sex with a partner who may be infected with Zika or who’s recently travelled to a Zika-affected area. If you work in a hospital, doctor’s office, lab or other health setting, follow workplace safety rules to avoid contact with infected body fluids or lab samples.
• Don’t smoke or expose yourself to smoke, drink alcohol or use street drugs. If you need help to quit doing these things, tell your provider.

See also: Your family health history, Genetic counseling

Last Reviewed June 2019