May 30, 2023
The following information is an easy-to-understand breakdown of the basics of clubfoot; what it is, how it's detected, and treatment.
What is Clubfoot?
Clubfoot is an infant deformity of the leg and foot where the foot is turned inward. It is a common birth defect occurring 1 in every 1,000 live births. Clubfoot affects the child’s bones, muscles, tendons, and blood vessels. Approximately half of children with clubfoot will have the condition in both feet. It is not painful for the infant, but without proper treatment, the child’s clubfoot will not improve, leading to difficulty in walking.
How is clubfoot detected? Most cases of clubfoot are diagnosed during a prenatal ultrasound, typically between 13 to 24 weeks of pregnancy. Some case are not diagnosed until birth. Most cases are congenital clubfoot meaning the are present at birth.
Treatment typically begins within the first few weeks of a child’s life, with the goal to correct the position of the feet allowing the bones, tendons, and muscles to grow correctly. After treatment the child is able to stand and walk with the sole of the foot flat on the ground.
The most common treatment method is non-surgical and called the Ponseti method. The first step of the treatment is to gently stretch and reposition the baby’s foot and hold it in place by casting. After a week, the cast is removed. The child’s foot is then stretched, repositioned, and cast again. This process is repeated weekly until the child’s foot has moved to the correct position.
The final step in the Ponseti method is a minor surgery called a tenotomy, in which the Achilles tendon is cut to lengthen it. The baby’s foot is then cast for a final time to protect the cut Achilles tendon. The final cast remains on the child’s foot for approximately 3 weeks. During this time the Achilles tendon regrows into the proper length and position.
The Ponseti method of treatment completely corrects the child’s clubfoot. However, the baby’s treatment must move to the bracing stage to prevent the natural tendency of clubfoot to recur. Infants typically wear a brace known as the boots and bar brace, which consists of a bar attached to each shoe or boot keeping the feet at the proper angle.
Babies will wear this boots and bar brace 23 hours a day for the first 3 months. Afterwards, a doctor will recommend gradually decreasing the number of hours the brace is worn until the child is only wearing it during sleep. By the time he or she is ready to crawl and walk, they can do so without the brace.
The child continues to wear a boots and bar brace while sleeping until the age of 4.
Early treatment is critical to the child’s outcome. If treatment begins right away, almost all babies will grow to have normally functioning feet, and will be able to walk, run, play, and wear normal footwear. Clubfoot that is left untreated will get worse with age and many children will only walk with difficulty.
One of the most common complications from wearing a brace is skin irritation. Children can develop redness, abrasions, and blisters caused from rubbing and irritation from the brace. Another common complication is athlete’s foot. Because the child must wear the brace for several hours during the day and night, moisture can lead to athlete’s foot.
The common complications can be distinctly improved by wearing the right sock with the brace. SmartKnit AFO brace socks can provide the child with much needed relief from and prevention of these irritations. The super soft and stretchy yarns are form-fitting preventing any wrinkling and bunching under the brace. Moisture-wicking fibers keep the socks dry, preventing athlete’s foot.
** Sources: Childrenshospital.org; orthoinfo.aaos.org; physio-pedia.com