Unilateral clubfoot is a common congenital foot deformity. This condition, also known as congenital talipes equinovarus (CTEV), causes the foot to appear twisted inward and downward. The term “unilateral” specifies that the deformity impacts only one foot, distinguishing it from bilateral cases where both feet are affected.
Understanding Unilateral Clubfoot
An infant with unilateral clubfoot presents with a foot turned inward, often with the sole facing sideways or upward. The toes typically point downward, and a deep crease may be visible on the sole. The affected foot and lower leg may appear slightly shorter, and the calf muscles can be noticeably thinner compared to the unaffected limb due to underdevelopment.
Despite its appearance, clubfoot does not cause pain or discomfort for the infant, allowing treatment to begin without immediate distress. It is important to distinguish between flexible (postural) clubfoot and rigid (true) clubfoot. Postural clubfoot is flexible and can sometimes resolve on its own or be manually corrected. True clubfoot is more rigid and requires medical intervention.
Causes and Diagnosis
The cause of clubfoot is often unknown, but it results from a combination of genetic and environmental factors. Genetic predispositions play a role, with a higher risk if there is a family history of the condition; for instance, the risk increases to 25% if a first-degree relative is affected. Certain genetic mutations, such as those in the PITX1 and HOXD10 genes involved in limb development, have been linked to clubfoot.
Most cases are isolated, but some instances can be associated with underlying genetic syndromes or neuromuscular disorders like arthrogryposis or spina bifida. Environmental factors during pregnancy, such as reduced amniotic fluid (oligohydramnios) or maternal smoking and drug use, also contribute to the risk.
Prenatal diagnosis of clubfoot occurs during routine ultrasound examinations, often around the 20th week of pregnancy. Ultrasound is the primary method for prenatal detection. Postnatal diagnosis is confirmed through a physical examination of the newborn’s foot, where a healthcare professional assesses its shape, position, and the tightness of connective tissues. This evaluation also helps differentiate between flexible positional feet and true rigid clubfoot.
Treatment Approaches
Early intervention for clubfoot is important, ideally beginning within the first few weeks of birth, as a newborn’s bones, joints, and tendons are still very flexible. The Ponseti method is the primary non-surgical treatment for congenital clubfoot. This method involves a series of gentle manipulations and plaster casts changed weekly to gradually correct the foot’s position.
Each weekly session involves a specialist gently stretching and repositioning the foot, working to correct the cavus (high arch), adductus (inward turning of the forefoot), and varus (inward turning of the heel) deformities. A long-leg plaster cast, extending from the toes to the thigh, is then applied to hold the foot in its new position. This casting phase typically involves 5 to 8 casts over six to eight weeks, depending on the foot’s rigidity.
Following casting, a percutaneous Achilles tenotomy is often performed. This procedure, required in most cases, involves a small incision to lengthen the Achilles tendon, allowing the ankle to dorsiflex (flex upward) and the heel to drop into a corrected position. After the tenotomy, a final cast is worn for approximately three weeks to allow the tendon to heal.
The final stage involves bracing with a foot abduction brace, consisting of special shoes attached to a bar. Initially, the brace is worn for 23 hours a day for about three months to maintain correction. Subsequently, it is worn during naps and overnight, typically for 4 to 5 years, to prevent relapse as the child grows. Surgical options are reserved for complex or recurrent cases that do not respond to the Ponseti method or for older children with residual deformities.
Life with Clubfoot and Long-Term Outlook
The Ponseti method has high success rates, with successful correction in over 90% of cases when the protocol is followed. Long-term success relies on consistent adherence to the bracing regimen, as non-compliance is the most common reason for recurrence. Children who consistently wear their braces as prescribed have a significantly lower chance of relapse.
Most children treated with the Ponseti method go on to live active, normal lives with minimal or no noticeable limp. While the treated foot may be slightly smaller (up to 1 to 1.5 shoe sizes smaller) and the calf muscles thinner than the unaffected side in unilateral cases, these differences rarely impede normal function. Regular follow-up appointments with orthopedic specialists are recommended throughout childhood to monitor the foot’s development and address any potential issues.