Clubfoot is a common congenital condition where the foot’s shape and position are noticeably altered. Early detection is important for planning appropriate care. This article explains how clubfoot is detected before and after birth.
Understanding Clubfoot
Clubfoot presents as a foot that is twisted inward and downward, often appearing as if the bottom of the foot faces sideways or even upward. This distinct appearance is due to the tendons connecting the leg muscles to the foot bones being shorter and tighter than typical. The affected foot and leg may also appear slightly smaller than the unaffected limb, with the calf muscles often reduced in size. Approximately half of all cases involve both feet, while others affect only one.
Prenatal Detection
Routine prenatal ultrasounds serve as the primary method for detecting clubfoot before birth. Sonographers typically look for the foot pointed downward and inward, specifically observing if the long axis of the foot, or sole, appears in the same plane as the tibia. This condition can sometimes be identified as early as 9 to 13 weeks of gestation, with approximately 80% of cases detectable by 24 weeks.
Despite its utility, prenatal detection through ultrasound has limitations and is considered a screening tool rather than a definitive diagnosis. The foot’s position in the womb can sometimes mimic clubfoot, leading to false positive rates ranging from 10% to 40%. These instances can occur if the foot is temporarily positioned unusually due to limited space or fetal movement. The severity of clubfoot cannot be accurately determined through prenatal ultrasound alone. If clubfoot is suspected during an ultrasound, additional evaluations, such as a Level II ultrasound, may be recommended to check for other potential conditions.
Diagnosis After Birth
Clubfoot is typically diagnosed immediately at or shortly after birth through a physical examination by a pediatrician or orthopedic specialist. During this hands-on assessment, the doctor carefully evaluates the foot’s shape and position. The flexibility and range of motion are also assessed as the doctor gently moves the foot to determine its stiffness and correctability.
The examination includes feeling the positioning of bones and the tightness of connective tissues. Other characteristics observed include a deep crease on the inside of the foot, a smaller calf muscle in the affected leg, and a slightly shorter foot size. While diagnosis is primarily visual and hands-on, X-rays may occasionally be used for a clearer understanding of bone positioning. Early diagnosis is important for prompt intervention, as untreated clubfoot can affect a child’s mobility.