What is club foot (talipes equinovarus)? What causes club foot?
A clubfoot, also known as club foot, congenital talipes equinovarus (CTEV), or talipes equinovarus (TEV) is a congenital deformity (present at birth) in which the affected foot appears rotated internally at the ankle – the foot points down and inwards and the soles of the feet face each other. 50% of patients with club foot have bilateral club foot (both feet are affected).
The tendons on the inside of the leg of people with club foot are shortened, the bones have an unusual shape and the Achilles tendon is tightened. If left untreated patients often appear to walk on their ankles or on the sides of their feet.
According to the National Institutes of Health (NIH), USA, approximately 1 in every 1,000 babies is born with club foot. Males are twice as likely to have the condition as females. According to the National Health Service (NHS), UK, if one child is born with club foot there is a 1 in 30 chance that his/her younger sibling will also be affected.
What are the signs and symptoms of club foot?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
- The top of the baby’s foot twists downwards and inwards.
- The arch is more pronounced and the heel turns inward.
- In severe cases the foot may look as if it is upside-down.
- The calf muscles are generally underdeveloped.
- If only one foot is affected, it is usually slightly shorter than the other (especially the heel).
- There is usually no discomfort or pain when the patient is not trying to walk.
When to see a doctor – in virtually all cases health care professionals will detect the condition when the baby is born; and sometimes before birth.
What are the risk factors for club foot?
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
- Gender – males are twice as likely as females to be born with club foot.
- Genetics – if a parent was born with club foot, there is a higher risk of his/her baby being born with the same condition. The same applies to siblings. According to the National Health Service (NHS), UK, if one parent has club foot there is a 3% to 4% chance that the child will have the same condition; if both parents were born with the condition the risk for their child is 15%.
At Washington University School of Medicine, USA, scientists traced the condition to a mutation in a gene critical for early development of lower limbs called PITX1.
What are the causes of club foot?
Club foot is mainly idiopathic – the cause is unknown.
Experts say the condition is not caused by the fetus’ position in the uterus.
Sometimes club foot may be linked to skeletal abnormalities, such as spina bifida cystica.
Diagnosing club foot
The condition is immediately visible at birth. It can also be detected before birth by ultrasound, especially if both feet are affected. If it is detected before birth no treatment is possible until after the baby is born.
If the condition is detected during pregnancy or after birth doctors will recommend more tests to determine whether the baby has any other health problems, such as spina bifida and muscular dystrophy.
Sometimes the doctor may order X-rays to observe the deformity in more detail.
What are the treatment options for club foot?
The aim of treatment, which occurs during the weeks following the baby’s birth, is to give the child functional feet which are free of pain.
- The Ponseti method – a specialist manipulates the baby’s foot with their hands. The aim is to correct the bend in the foot. Then a plaster cast is applied from the patient’s toes to their thigh to hold the foot in position. Each session is generally done once a week. The manipulation and casting are done very gently and the patient should experience no pain.
At each session the plaster cast is changed, and each time the foot is corrected a tiny bit more. The whole process may be done 4 to 10 times (4 to 10 new casts used).
Surgery – the doctor will then (after Ponseti method treatment) decide whether a minor operation on the Achilles tendon (to release it) is needed.
When the foot is eventually corrected the patient has to wear special boots attached to a brace to hold the foot (feet) in the best position. For two to three months the boots are worn 23 hours a day; eventually they are just worn at night and during daytime naps – until the patient is about four years old.
For the Ponseti method to be effective it has to be done very early on and parents have to make sure the boots are worn according to instructions. If instructions are not followed strictly, the foot may go back to the way it was, and treatment has to start again.
- The French functional method – consists of daily stretching, exercise, massage, and immobilization of the foot with nonelastic tape to slowly move the foot to the correct position. These therapy sessions are performed primarily by a physical therapist for the first three months, when most of the improvement occurs, but parents receive training during this time in order to perform some of the treatments at home. The taping and splinting continues until the child is two years old. It is important to note that this method is currently not available in many parts of the United States.
This interesting article compares the French functional method with the Ponseti method.
If club foot is an isolated deformity (nothing else is wrong), treatment is usually completely successful. Sometimes the defect may not be totally correctable – even so, in such cases the appearance and function of the foot will improve significantly.
What are the possible complications of club foot?
If left untreated
An untreated baby will usually feel no pain or discomfort until they have to stand and walk. The risk of eventually developing arthritis is significant. The unusual appearance of the foot may cause self-image problems later in life.
The individual will find it hard to walk on the soles of the feet, using instead the balls of the feet, the outside of the feet, and in very severe cases the top of the feet.
Famous people born with a club foot
- Claudius (Roman emperor)
- Tutankhamen (Egyptian pharaoh)
- Thaddeus Stevens (American Civil War politician)
- Dudley Moore (English actor, comedian, musician)
- Damon Wayans (American actor, comedian)
- Eric Richard (English actor in UK police series “The Bill”)
- Sir Walter Scott (Scottish novelist)
- Troy Aikman (American football player, TV presenter)
- Steven Gerard (English soccer player)
- Lord Byron (English romantic poet)
- Kristi Yamaguchi (Went on to win figure skating gold medal in 1992 Olympics)
- Joseph Goebbels (Nazi propaganda minister)