Clubfoot, medically known as Congenital Talipes Equinovarus (CTEV), is a common birth difference affecting the structure of the foot and lower leg. This condition is present at birth, involving the foot being twisted inward and downward due to shortened tendons and ligaments. Clubfoot occurs in about one in every 1,000 live births and is correctable with modern non-surgical methods. While the appearance may be alarming, prompt treatment can lead to a foot with good function and appearance.
The Defining Visual Characteristics
The appearance of a clubfoot is characterized by three distinct positional changes that give the foot its classic curved shape. The entire foot is held in a downward-pointing position at the ankle, known as equinus, similar to a ballerina standing on her toes. This position results from tight tissues, including the Achilles tendon, pulling the heel up and preventing the foot from moving upward toward the shin.
The heel is turned sharply inward, a deviation called varus, so that the bottom of the heel faces the opposite foot instead of resting flat on the ground. This inward rotation makes the back of the foot appear concave or hollow. Additionally, the forefoot is turned inward and angled toward the midline of the body, a component known as adduction.
The combination of the inward-turning forefoot and the inward-pointing heel creates a pronounced “C” shape or a bean-like curve along the outer edge of the foot. The arch of the foot also appears unusually high, a condition called cavus, further contributing to the foot’s distorted shape. The rigidity of the foot means that these misalignments cannot be easily straightened out with a gentle touch.
Understanding the Degrees of Severity
The visual presentation of clubfoot can vary significantly, often relating to whether the condition is structural or positional. A key difference lies in the foot’s flexibility when examined by a medical professional. True clubfoot, or idiopathic CTEV, is a fixed deformity involving structural changes in the bones and connective tissues, presenting as a stiff and rigid foot at birth.
This fixed type maintains its characteristic inward and downward position even when gentle pressure is applied. The structural nature of the deformity means the bones have developed in an altered alignment, which requires a progressive treatment method to correct. The visual severity, scored by systems like the Pirani score, is directly related to how rigid and resistant the foot is to manual correction.
In contrast, a positional clubfoot, sometimes called postural talipes, is less severe and is not a true structural deformity. This condition is often caused by the baby’s prolonged position in the womb, which compressed the foot into an atypical shape. Visually, a positional clubfoot can look similar to a true clubfoot, but the difference becomes clear when the foot is gently manipulated. A positional foot is flexible and can be passively moved to a normal or near-normal position by hand, indicating that the bony structure is fine.
Related Physical Features
Clubfoot frequently presents with other observable physical characteristics in the affected limb. The calf muscle on the side with the clubfoot is often noticeably smaller and less developed compared to the unaffected leg, a difference known as calf atrophy. This size discrepancy typically persists even after successful correction of the foot deformity.
The skin around the foot and ankle may also show specific visual signs. Deep skin creases are commonly present on the back of the heel and along the inner side of the foot near the arch. These creases are a consequence of the tight tendons and the foot’s severe inward angulation, causing the skin to fold noticeably.
Another common feature is a difference in overall size, as the affected foot is often shorter than the unaffected foot, sometimes by up to one or one and a half shoe sizes. This smaller size, combined with the characteristic bean-like shape, contributes to the overall visual assessment of the condition.