Clubfoot, medically known as congenital talipes equinovarus, is a common birth defect where an infant’s foot typically turns inward and downward, often appearing rotated.
Understanding Clubfoot
In clubfoot, the foot may appear kidney-shaped with a deep crease on the inside, a higher-than-normal arch, and an inward-turning heel. The tendons connecting leg muscles to foot bones are shorter and tighter than usual, pulling the foot into this characteristic twisted position. The affected leg might also have a slightly smaller calf muscle and shorter foot.
It is important to distinguish between true clubfoot and positional clubfoot. True clubfoot is a structural deformity where the foot is stiff and cannot be easily manipulated into a normal position, involving abnormalities in the bones, muscles, and tendons. In contrast, positional clubfoot occurs when a baby’s foot is held in an unusual position in the womb, but the foot structure itself is normal and flexible. This condition typically corrects with gentle stretching and does not involve fixed deformities. Clubfoot can affect one foot (unilateral) or both feet (bilateral), with about half of affected infants having it in both feet.
Global Prevalence and Statistics
Clubfoot is one of the more common congenital musculoskeletal abnormalities. Globally, recent analyses estimate the prevalence at around 1.18 per 1,000 live births, translating to an estimated 176,476 children born with the condition worldwide each year.
Prevalence rates for clubfoot vary across different populations and regions, being twice as common in males compared to females. Some regions, like South-East Asia and Africa, show higher rates, while others, such as populations of Chinese descent, have lower prevalence.
Factors Influencing Clubfoot Occurrence
The exact cause of clubfoot is often not known, and it is considered a multifactorial condition, meaning it likely results from a combination of genetic and environmental influences. Genetic predisposition plays a role, as a family history of clubfoot increases the likelihood of a child being born with the condition. Studies on twins also support a genetic component, showing a higher likelihood in identical twins compared to fraternal twins. Specific genes involved in limb development have also been linked to clubfoot.
Environmental factors during pregnancy may also contribute to clubfoot development. Maternal smoking during pregnancy is associated with an increased risk. Insufficient amniotic fluid (oligohydramnios) can restrict fetal movement and potentially contribute to the condition. Clubfoot can also occur as part of broader conditions, including spina bifida, arthrogryposis, or Trisomy 18.
Treatment Approaches and Long-Term Outlook
Early intervention is important for clubfoot, with treatment ideally beginning within the first few weeks after birth. The primary method of treatment is the Ponseti method, which is widely recognized as an effective non-surgical approach. This method involves a series of gentle manipulations of the foot, followed by the application of plaster casts, typically changed weekly. Most infants will also require a minor procedure to lengthen the Achilles tendon, performed towards the end of the casting phase.
Following the casting, a foot abduction brace is used to maintain the corrected position. This brace is worn nearly full-time for the initial months, then primarily during naps and at night, often until the child is four or five years old. The Ponseti method has high success rates, with over 90% of cases achieving good correction without major surgery; surgery is rarely needed for idiopathic clubfoot and is typically reserved for severe cases or when conservative treatments are unsuccessful. With proper and timely treatment, children born with clubfoot can lead active lives, participate in sports, and wear regular shoes without pain. While the affected foot may remain slightly smaller and the calf muscle less developed, these differences typically do not cause significant functional problems.