Also known as tallipes equinovarus, is a deformity of the foot that is present at birth. The foot is twisted inward and pointed down. If not treated, the deformity causes a problem with walking and wearing shoes when the baby grows. The cause of clubfeet is not known, but often runs in families. One or both feet can be affected and usually the calf muscles and foot are smaller than normal. Some clubfeet deformities are mild and flexible, while others are more severe and very stiff. Fortunately, treatment can correct the foot deformity so the foot will be in good alignment and the child can be fully active.
Diagnosis is made by examining the baby’s feet. Sometimes the foot deformity is found on the mother’s prenatal ultrasound before the baby is born. A thorough history and physical examination will be done to determine if there are other medical concerns going on as well. The earlier treatment can be started, the better the outcome will be.
Treatment involves using a series of casts changed once a week, each time gently stretching the foot into a more normal position. This treatment is called the Ponseti Method named after Dr. Ignacio Ponseti of Iowa who developed the treatment over 50 years ago. It was found that children have fewer problems with their feet if they were treated with this technique instead of extensive surgery. After about 5 or 6 cast changes, most babies need a very small incision of the Achilles tendon (heel cord) to bring the heel into a flat position. After the casting is done, the baby will wear special shoes attached to a bar all the time for the first few months, then at night time only for the next few years.
Surgery is sometimes needed for children with more severe clubfeet who have recurrence of the deformity. Usually these surgeries are done after age 3 and often involve transferring a tendon to keep the foot in good alignment.