Club foot

Club foot is a deformity of the foot and ankle that is present at birth (congenital).

Information written and reviewed by Certified Doctors.

Contents

Introduction

Club foot is a deformity of the foot and ankle that is present at birth (congenital). If it is treated early, the position and function of the foot can be greatly improved.

In a baby born with club foot, the foot points down and inwards with deep inner and heel creases, and the soles of the feet face backwards.

What causes club foot?

In most cases the cause of club foot is unknown. There is evidence of a genetic link, but no other causes have been confirmed.

If you have one child with clubfoot then your risk of having a second child affected is 1 in 35.

Club foot affects one baby in every 1,000 born in the UK and is one of the most common congenital abnormalities.

Boys are twice as likely to be affected as girls and around half of the children born with club foot will have both feet affected.

Treatment

Treatment for club foot should ideally start within a week or two of the baby being born, but can still be effective if started much later.

A treatment technique known as the Ponseti method is the main treatment for club foot, which involves your baby's foot being gently manipulated into position and put in a cast. The gentle manipulation involves gradually stretching out the ligaments and reshaping the bones of the foot, until the foot is in a normal position.

This is repeated weekly for an average of five weeks, but shouldn't take longer than eight weeks.

After this series of casts, it is likely your baby will need a very small and quick procedure called an Achilles tendon tenotomy, usually performed under local anaesthetic. This allows the foot a more normal range of movement. The tendon takes two to three weeks to heal in a plaster.

After this, your baby will need to wear special boots, attached to a bar. These are only worn full time for the first three months, then overnight until your child is at least four years old. During the day, your child can wear normal footwear and should start to walk and run at the same time as any other child.

Although the Ponseti method can be a time-consuming process to go through, it is not painful and in around 95% of cases it is an effective method of treating babies with club foot. It is important to stick to the treatment, particularly the use of the boots and bar, to prevent club foot re-occurring.

Your child’s condition will be regularly reviewed in case they have a relapse and require further treatment.

Evidence shows that effective treatment with the Ponseti method can ensure a child with clubfoot will have pain-free, normal looking feet that function well.

However, there are a small number of children with clubfoot that cannot be fully treated with the Ponseti Method. This can be due to other underlying conditions which make treatment more challenging. Some children will require further surgery which have a less successful outcome.

Read more about treating club foot.

Diagnosis

Club foot can often be diagnosed before a baby is born. However, sometimes it is discovered at birth during the physical examination of the baby.

Unborn babies

Club foot can be detected in an unborn baby using an ultrasound scan. However, it cannot be treated before birth.

If club foot is detected in the womb, you may have further tests to determine whether your baby has any other problems, such as restricted growth (see below).

An ultrasound scan is a fairly accurate method of diagnosing club foot, but it is not 100% reliable. Therefore, if club foot is suspected, you will be told about the condition and the type of treatment that will be needed. Your child may be referred to a specialist in treating conditions that affect the bones, usually an orthopaedic surgeon.

At birth

Your newborn baby will usually be given a physical examination within 24 hours of being born. This will include examining the baby’s feet and legs. Club foot will usually be immediately visible.

If your baby has club foot they will be referred to an orthopaedic surgeon.

Other conditions

If club foot is diagnosed, your baby may also be checked for other, associated conditions such as:

  • spina bifida – a series of birth defects that affect the development of the spine and the brain
  • other neurological conditions
  • conditions that cause short stature, stiff joints and collagen defects - collagen is a protein that supports tissue and gives it strength

Treatment

If your baby has club foot, treatment will usually begin within a week or two of their birth. The aim is to improve the position and function of your baby's foot and minimise any pain.

The Ponseti method

A technique called the Ponseti method (named after Dr. Ignacio Ponseti who developed it) is the main treatment for club foot. An increasing number of orthopaedic specialists (bone specialists) use the Ponseti method and it is available in many clinics. However, not all hospitals provide the service.

The Ponseti method is successful in treating more than 8 out of 10 cases of club foot. Long-term results are also very promising compared to previous surgical treatment methods.

One long-term study followed up people with club foot who had been treated with the Ponseti method 30 years ago. Over three-quarters of the people who were treated either had good or excellent function in their feet. This was only slightly less than a group of people of similar ages who were questioned about pain in their feet and had never had club foot.

How it works

The Ponseti method involves weekly sessions with a specialist, or another trained healthcare professional, who will manipulate your baby's foot with their hands, gradually altering the bend in their foot. They will then apply a plaster cast from your baby's toes to their thigh to hold the foot in its new position.

The casts will be changed weekly at each session and your baby's foot will be altered a little more each time. On average, five or six casts are usually used, but your baby may need to have a few more or a few less, depending on the severity of the condition.

Your baby's foot will be manipulated gently, so the procedure should not hurt them. Babies will often cry during manipulation and casting although it is not usually due to pain.

Achilles tendon surgery

Following the Ponseti method, your specialist will decide whether your baby needs to have a small operation to release the tight tendon at the back of their heel (the Achilles tendon). This is a very minor operation that most babies with club foot will need to have.

Achilles tendon surgery is often recommended after the front of the foot has been manipulated (usually after the fourth or fifth cast) but when the ankle cannot be fully altered.

The procedure is usually carried out under a local anaesthetic on an outpatient basis, which means that your baby will not have to stay in hospital over night. In some cases, a general anaesthetic may be used so that your baby will be unconscious during the operation.

During the procedure, the surgeon will make a small cut in your baby’s heelcord to release their foot into a more natural position. Your baby’s foot and leg will be put in a plaster cast for about three weeks.

A small number of children will require further surgery when they are between two and seven years of age. This may involve moving a tendon in front of the ankle to a different position to improve the foot’s function.

Boots and bar

After your baby’s foot has been treated, they will need to wear special boots that are attached to a bar (brace). This will hold their feet in the most effective position. The boots have straps to attach them firmly to your child’s feet and the bar will keep their feet about shoulder distance apart.

The boots will need to be worn 23 hours a day for three months, and then after this time just at night and nap times until your child is about four years of age.

It is very important that your child wears the boots for the required amount of time otherwise their foot may return to how it was previously and treatment may have to begin again.

Relapse

Sometimes, club foot can reoccur. This is known as a relapse and it is estimated to occur in one or two out of every 10 cases. Relapses are more likely if the treatment method described above is not followed exactly.

If club foot reoccurs, it may be necessary for some of the treatment stages to be repeated - for example, your child may need to have their foot manipulated again and put in a cast.

In some cases, ensuring that your child continues to wear the boots and bar may be enough to improve their club foot significantly. However, in other cases where there has been a relapse, surgery may be required.

Content supplied by NHS Choices