Clubfoot is a congenital musculoskeletal condition where children are born with one or both feet twisted inwards and pointed downwards that affect the shape and position of a baby’s foot. This twisting results in the toes being directed towards the opposite leg. A clubfoot doesn't cause pain and won't lead to health issues until the child starts standing and walking. However, if left untreated, clubfoot can result in serious complications, potentially making it impossible for a child to walk. The chances of having this foot deformity in newborn babies are approximately 1-2 in 1000 live births all over the world. This congenital abnormality relates to defective formation of connective tissue. The prevalence is higher in males than in females. It is one of the commonest and oldest recognized orthopaeadic anomalies.
Sarvodaya Hospital, the top hospital in Delhi NCR, is renowned for its comprehensive and exceptional paediatric orthopaedic care, particularly for clubfoot treatment (Congenital Talipes Equinovarus or CTEV). With a dedicated team of highly skilled paediatric orthopaedic surgeon in Faridabad and state-of-the-art facilities, Sarvodaya Hospital ensures that children with clubfoot receive holistic and patient-centric care tailored from initial diagnosis to post-treatment rehabilitation.
The purpose of this blog is to discuss clubfoot in infants, including its causes, symptoms, treatment options, and how Sarvodaya Hospital, a trusted name in paediatric orthopaeadics, offers treatment modalities for clubfoot.
Types of Congenital Clubfoot:
It can be divided according to their causes.
- Idiopathic: It is an isolated birth defect. It is the most common type of birth defect and is associated with no other anomalies.
- Non-idiopathic: It is a non-isolated clubfoot associated with other medical conditions. These conditions include spina bifida. It is a neurological disorder of newborn brain, spine, and spinal cord. The other condition is arthrogryposis. It is a common condition of CTEV since birth. Multiple joints are linked to this condition, which causes clubfoot deformity.
Features of Clubfoot in Babies
- Benign/postural or positional clubfoot: The foot's position can be effectively corrected using casting and physiotherapy.
- Moderate/soft more than stiff clubfoot: As per study, this category represents approximately 33% of cases. It responds to casting. For those that don't improve within 7-8 months, surgical intervention may be required.
- Severe/stiff more than soft clubfoot: It occurs in 61% of cases. Over half of the cases don’t respond to conservative treatment and typically require surgical intervention.
- Very severe/stiff clubfoot: It is an irreducible congenital anomaly, often affecting both sides, and is mostly required extensive surgical repair.
Symptoms of Clubfoot in Babies:
- The foot is bent downward and inward, giving the impression that the baby is standing on the side of the foot. The clubfoot slightly more affects the right side than the left.
- The affected foot may be smaller and less mobile compared to the other foot or both feet may be affected.
- Restriction of motion in the foot and ankle.
- The calf muscles on the affected side may seem underdeveloped or usually smaller.
- In more serious cases, the foot might appear stiff and may not move easily with gentle manipulation.
For better management and treatment, the symptoms listed above may make medical intervention more necessary.
Causes of Clubfoot in Babies
- Genetic factors: Genetic factors such as family history and inheritance patterns play a significant role in the development of clubfoot in babies. The increased prevalence in cases of previous family history.
- Positioning in the womb: Low levels of amniotic fluid in the womb can restrict foot movement and the development of foetus.
- Environmental factors: Smoking by mothers during pregnancy might be a cause of increased risk of clubfoot.
Diagnosis of Clubfoot in Babies
- Prenatal Diagnosis: Prenatal ultrasonography examination offers positive diagnosis results with zero error. Although most cases of clubfoot are diagnosed at birth, the advent of ultrasonography into healthcare enables the doctors to recognize the condition before birth. Its importance lies in preparing the parents to be ready to the degree of postnatal management as early as possible. It is also essential to provide assurance to parents that the case is treatable and there is no means of abortion.
- Physical appearance of clubfoot: Immediately after birth, an orthopaedic surgeon typically diagnoses clubfoot by taking a complete history from the parents and examining the shape of the foot. The doctor then palpates the foot bones and surrounding connective tissues to identify any abnormal positions and contractures. Affected cases should be thoroughly examined from head to toe to rule out other associated congenital anomalies.
- Diagnostic Tests: Despite the advancements in radiology that have been introduced in health investigations, the clinical evaluation remains the more informative method for diagnosing clubfoot. Magnetic resonance imaging (MRI) is also employed in the evaluation of treatment and management.
Clubfoot Treatment & Management:
Conservative Treatment
Clubfoot is mostly managed through conservative methods, including the Ponseti method and French method that provides the best possible outcomes for positional and moderate newborn clubfoot treatment. Medical professionals suggest treating the condition as early as possible to avoid problems later. However, such conservative methods are often unsuccessful for correction of deformity in cases of severe rigid clubfoot. Nowadays, orthopaeadic surgeons opt for the Ponseti method, which involves a sequence of casts, careful foot stretches and movements, and a brace to gradually correct the foot’s position.
- Ponseti method: The Ponseti method consists of two primary phases: casting and bracing.
Casting Phase: This phase begins when the baby is about one to two weeks old. The initial cast is applied, and then the baby visits the orthopaedic surgeon approximately once a week. During these visits, the surgeon carefully moves and stretches the foot and replaces the old cast with a new one. Each new cast adjusts the foot slightly more towards the correct position. Generally, babies will need to wear 5 to 7 casts over a period of several weeks or months.
Bracing Phase: Once the foot has been properly aligned, the orthopaedic surgeon will replace the cast with a brace, also known as an orthotic. The brace consists of a bar with specialized shoes or boots at each end. This device prevents the foot from reverting to its original clubfoot position. As feet tend to grow rapidly during the first year of life, the brace is essential to maintaining the corrected alignment. Without it, the foot would likely revert to the clubfoot position due to the quick growth during infancy.
A child has to wear the brace continuously for the first three months. After this period, they will only need to wear it during the night or while napping for a few more years.
- French method: This method is almost identical to the Ponseti method, but it replaces casting with splinting and taping. A splint is a supportive device designed to protect bones.
Initially, a physiotherapist is responsible for performing this treatment, which begins shortly after birth. Afterwards, this physical therapy will be taken care of by parents after they get trained by the physiotherapist. Unlike the weekly visits to hospital required in the Ponseti method, this treatment must be done daily at home. Instead, the physiotherapist will see your child once or twice a week and provide parents with instructions on how to apply the splinting and taping at home.
Newborn clubfoot treatment helps orthopaedic surgeons in preoperative planning and contributing to the development of non-surgical corrective procedures for clubfoot deformity in babies. However, this may lead to serious challenges due to unresponsiveness of severe rigid cases of deformity to many options of management. For this, there are many surgical options for correction of the deformity.
Surgical Treatment:
Severe rigid clubfoot doesn’t resolve on its own. Thus, surgery is the go-to solution. Surgical interference is best operated at 9–10 months when the time comes for infant to attain standing position and carry to put his own body weight on the feet. Performing surgery in such cases necessitates a highly skilled orthopaedic surgeon to minimize residual scarring and stiffness that can result from operating on immature structures. Hence, it is crucial that these surgeries are conducted by expert paediatric orthopaedic surgeons in Faridabad.
Contemporary clubfoot correction surgery can be classified into three main categories, the first involving only soft tissue, the second focusing solely on bones, and the last that addresses both soft tissue and bones.
Clubfoot is a common birth defect and is a treatable condition. Early intervention is highly effective, ensuring the best possible outcome for affected children. At Sarvodaya Hospital, the paediatric surgery hospital in Faridabad, we exclusively cater services and have the best clubfoot treatment in India. An orthopaeadic surgeon’s recommendation is crucial, as it significantly enhances the likelihood of success. With proper treatment, many children with clubfoot are able to walk, run, and participate in sports without discomfort. If you suspect your baby has clubfoot, consult with a paediatric orthopaedic surgeon for a proper diagnosis and most suitable treatment for your child’s clubfoot.
