Clubfoot

If your child has been diagnosed with a club foot, you’ll have concerns and questions about his health, treatment, recovery and other issues. It may comfort you to know that Children’s Hospital Boston is a world leader in pediatric orthopedics, and we have a wealth of experience treating children with this fairly common and highly treatable condition.

What to know about club foot
Club foot (also known as talipes equinovarus) is a congenital (present at birth) foot deformity. It affects the bones, muscles, tendons and blood vessels and can be present in one or both feet.

In club foot, the heel points downward, while the front half of the foot turns inward. The calf muscles on the affected side are smaller than on the normal side; the leg on the affected side is slightly shorter than on the other side. The foot itself is usually short and wide, and the heel cord (Achilles tendon) is tight.

• The condition is fairly common, occurring in about one of every 1,000 newborns.
• It affects boys twice as often as girls.
• Fifty percent of club foot cases affect both feet (bilateral).
• A club foot is visible at birth, and is often detected by fetal ultrasound before birth.
• The “Ponseti”method—manipulating the foot into correct position without joint surgery—is the standard treatment, and usually begins shortly a baby is born. The method involves:
  • a two to three-month regimen of stretching and casting
  • surgery (tenotomy) to release and lengthen the Achilles tendon
  • several years of bracing

Twenty to 30 percent of kids need additional interventions later on in childhood for tendon tightness or to prevent recurrence of the condition.

• Most instances of club foot are idiopathic (no apparent cause).
• A club foot that occurs with some genetic syndromes and birth defects—such as Edwards syndrome (trisomy 18) or spina bifida (myelodysplasia)—can be more fixed, rigid and difficult to treat.
• Most children who are properly treated for club foot can run, play and live active lives, even though technically their foot and leg remain mildly abnormal.

How Boston Children's Hospital approaches club foot
The goal of treatment for club foot is to correct the position of the foot, so that the bones grow normally. Children's doctors take conservative, non-surgical approaches whenever possible, and we have excellent success rates. If a newborn needs surgery, we try to avoid using general anesthesia, which does pose some risk to infants.

Compared with many other institutions, we offer an especially strong and supportive bracing program. We also have an exceptional prenatal counseling program to help parents anticipate and plan for their baby’s care after birth.

At Children’s, we recognize the burden of a bracing regimen, which is absolutely necessary to successfully treat club foot, but which places stress on both the child and the family, particularly after a child reaches 2 years old. That’s why we’re initiating a research study to try to predict which children are less likely to have problems with their feet after they’re 2, so that they could reduce or discontinue their bracing programs.

One of the first programs.Our Orthopedic Center is one of the world’s first comprehensive pediatric orthopedic programs, and today is the largest pediatric orthopedic surgery center in the United States, performing more than 5,000 procedures each year. Our program, consistently ranked among the top three in the country by U.S.News & World Report, is the nation’s preeminent care center for children and young adults with developmental, congenital, post-traumatic and neuromuscular problems of the musculoskeletal system.

Club foot: Reviewed by Susan Mahan, MD, MPH

© Children’s Hospital Boston, 2011