CONGENITAL CLUBFOOT


Clubfoot is a birth defect where one or both feet are rotated inwards and downwards. The affected foot, calf, leg may be smaller than the other. In about half of those affected both feet are involved. Congenital clubfoot is present at the time of birth and affects the foot or ankle. There is no known cause for clubfoot, and it is twice as common in male children as it is in female children. The frequency of congenital clubfoot is approximately 1 per 1,240 live births. In children with clubfoot, there is a subtle imbalance in muscle forces in the lower leg resulting in the foot deformity. Often, the foot is "kidney-shaped." About 50 percent of the time, both feet are affected with clubfoot.
Clubfoot is mainly idiopathic, which means that the cause is unknown. Genetic factors are believed to play a major role, and some specific gene changes have been associated with it, but this is not yet well understood. It appears to be passed down through families. It is not caused by the fetus' position in the uterus. Sometimes it may be linked to skeletal abnormalities, such as spina bifida cystica, or a developmental hip condition known as hip dysplasia or developmental dysplasia of the hip (DHH) .It may be due to a disruption in a neuromuscular pathway, possibly in the brain, the spinal cord, a nerve, or a muscle. Environmental factors may play a role. Research has found a link between the incidence of clubfoot and maternal age, as well as whether the mother smokes cigarettes, gestational diabetes. A link has also been noted between a higher chance of clubfoot and early amniocentesis before 13 weeks of gestation during pregnancy.
Although different types of clubfoot exist, the condition is usually accompanied by the following foot deformities:
  • Plantar flexion: Twisting of the ankle.
  • Cavus foot deformity: An unusually high arch in the foot.
  • Varus: An inversion of the heel that causes the front of the foot to turn inward.
  • Adduction of the forefoot: the forefoot is pulled downward.
Other symptoms include:
  • Stiffness in the ankle or foot tendons
  • One calf appears shorter than the other
  • Affected foot lacks full range of motion
In some cases, clubfoot can be corrected via exercise, stretching of the heel cord and casting. Corrective casting employs gentle stretching of the foot with application of a holding cast to maintain corrected position. The manipulation and casting are repeated on a weekly basis until the deformity is either corrected or the degree of correction plateaus.
Surgery for children with congenital clubfoot is best done prior to walking age as walking then will not be significantly delayed. The goal of surgery is to lengthen the heel cord and correct the forefoot and hind foot. Clubfoot surgery can be performed after 1 year of age; however results typically are less satisfying. Risks of congenital clubfoot surgery include nerve injury, infection, bleeding, and stiffness

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