Clubfoot

What Is Clubfoot?

Clubfoot, medically known as Congenital Talipes Equinovarus (CTEV), is a congenital foot deformity in which one or both feet are positioned inward and downward at birth.

The affected foot may appear smaller and shorter than the other foot, with the heel elevated and the arch of the foot more pronounced than usual. The severity can range from a flexible deformity to a more rigid and stiff foot.

When left untreated, clubfoot can affect weight-bearing and the development of a functional walking pattern.

The Main Types of Clubfoot

Clubfoot can be classified according to its underlying cause and associated conditions:

• 1.Idiopathic Clubfoot: The most common type, occurring in otherwise healthy infants without an identifiable cause.
• 2.Neurogenic Clubfoot: Associated with conditions affecting the nervous system, such as spina bifida or cerebral palsy.
• 3.Syndromic Clubfoot: Occurs as part of a broader genetic, neurological, or skeletal condition, such as arthrogryposis.
• 4.Positional Clubfoot: Related to the baby's position inside the uterus and is usually more flexible, without significant underlying bone deformity.
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Signs and Symptoms:

A child with clubfoot may present with:

• 1.Inward and downward positioning: The front of the foot turns inward and downward toward the opposite leg.
• 2.High arch (Cavus): The arch of the foot is higher and more pronounced than normal.
• 3.Deep skin creases: Particularly on the sole or inner side of the foot.
• 4.Smaller foot and calf: The affected foot and calf muscles may be slightly smaller than the opposite side.
• 5.Stiffness: The foot and ankle may resist manual correction toward a more typical position.
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Causes and Risk Factors:

The exact cause of idiopathic clubfoot is not completely understood. It is thought to involve a combination of genetic and biological factors.

Factors associated with an increased likelihood of clubfoot include:

• A family history of clubfoot.
• Male sex, as clubfoot occurs more frequently in boys than girls.
• Certain factors during pregnancy, including maternal smoking.
• Neurological, muscular, or skeletal conditions associated with non-idiopathic clubfoot.
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Diagnosis and Early Intervention:

Some cases of clubfoot can be identified during pregnancy through fetal ultrasound. However, diagnosis is most commonly made after birth through a clinical examination.

Early treatment is important to achieve optimal correction and support the child's development of standing and walking skills.

Treatment and the Ponseti Method

The Ponseti Method is the most widely used conservative treatment for idiopathic clubfoot. It generally involves the following stages:

1. Serial Casting

The foot is gently manipulated toward the corrected position, followed by the application of a long-leg cast, which is usually changed weekly.

Treatment typically continues for several weeks, depending on the severity of the deformity and the child's response to correction.

2. Achilles Tenotomy

Some children require a minor procedure to lengthen the Achilles tendon when limited ankle dorsiflexion remains after the initial correction.

The procedure is determined by the orthopedic specialist and is usually followed by a final period of casting.

3. Bracing

Once correction has been achieved, a Foot Abduction Brace (FAB) is used to maintain the corrected position and reduce the risk of recurrence as the child grows.

Consistent adherence to the bracing program is an important part of long-term treatment success.

The Role of Physical Therapy:

Physical therapy provides supportive rehabilitation during and after correction, with the goal of optimizing foot function and supporting the child's overall motor development.

Depending on the child's needs, therapy may include:

Flexibility and Mobility

Gentle stretching and mobility exercises to maintain the available range of motion and the alignment achieved after correction.

Muscle Activation

Functional activities that encourage appropriate use of the lower-leg and ankle muscles and improve motor control.

Weight-Bearing Training

Progressive activities to develop standing and weight-bearing while maintaining appropriate foot and ankle alignment.

Balance and Gait Training

Age-appropriate activities to improve balance, weight shifting, motor control, and functional walking skills.

Post-Correction Follow-Up

Monitoring range of motion, strength, weight-bearing, and gait, while identifying any changes that may suggest recurrence in coordination with the orthopedic team.

The Bracing Phase: Maintaining Correction

A Foot Abduction Brace (FAB) is commonly used after correction. It consists of two shoes connected by a bar that maintains the feet in the prescribed position.

The orthopedic specialist determines the duration of brace use, foot position, and daily schedule according to the child's age, condition, and response to treatment.

For idiopathic clubfoot, adherence to the bracing program is particularly important because early discontinuation or inconsistent use may increase the risk of recurrence.

Home Care and When to Contact the Medical Team:

Parents can help maintain treatment results by following the orthopedic and therapy recommendations and regularly checking the child's feet and brace.

Parents should:

• Ensure that the heel is properly positioned inside the shoe.
• Check the skin regularly for persistent redness or areas of pressure.
• Follow the prescribed bracing schedule.
• Perform recommended home exercises correctly.
• Contact the medical team if the heel begins to lift, the foot becomes increasingly stiff, or the foot starts turning inward again.

Early identification of recurrence is important. In some cases, recurrence can be managed with a period of repeat casting rather than requiring additional surgery.

What Should Parents Expect?

Clubfoot is highly treatable, particularly when treatment begins early and the recommended program is followed consistently.

Successful treatment does not end when the foot is initially corrected. Continued bracing and regular follow-up are important throughout the child's growth.

The goal is to maintain correction, support weight-bearing and motor development, and help the child achieve functional and comfortable walking

Clubfoot Care at The One Physical Therapy Center:

At The One Physical Therapy Center, we work as part of a multidisciplinary team to support children throughout their treatment and rehabilitation journey.

We assess mobility, flexibility, strength, weight-bearing, balance, and gait, and develop an individualized therapy program based on the child's age, stage of treatment, and functional needs.

Physical therapy is provided in coordination with the orthopedic specialist, particularly during the casting and bracing phases, to ensure that rehabilitation goals remain consistent with the correction plan.

Our goal is not only to support foot correction, but also to help the child use the foot effectively during standing, walking, and everyday activities.

 

References:

1. Balasankar, G., Luximon, A., & Al-Jumaily, A. (2016). Current conservative management and classification of club foot: A review. Journal of Pediatric Rehabilitation Medicine, 9(4), 257–264.
2. De Mulder, T., Prinsen, S., & Van Campenhout, A. (2018). Treatment of non-idiopathic clubfeet with the Ponseti method: A systematic review. Journal of Children's Orthopaedics, 12(6), 575–581.
3. Morcuende, J. A., Dolan, L. A., Dietz, F. R., & Ponseti, I. V. (2004). Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics, 113(2), 376–380.
4. Rosselli, P., Nossa, S., Huérfano, E., Betancur, G., Guzmán, Y., Castellanos, C., & Morcuende, J. (2015). Prenatal ultrasound diagnosis of congenital talipes equinovarus in Bogota (Colombia) between 2003 and 2012. Iowa Orthopaedic Journal, 35, 156–159.
5. Dobbs, M. B., & Gurnett, C. A. (2009). Update on clubfoot: Etiology and treatment. Current Opinion in Rheumatology, 21(1), 69–72.
6. Zionts, L. E., Dietz, F. R., & Morcuende, J. A. (2012). Bracing in the treatment of idiopathic clubfoot. Journal of the American Academy of Orthopaedic Surgeons, 20(10), 639–647.
7. van der Ven, C. A. M., et al. (2023). Factors associated with relapse in children with clubfoot treated using the Ponseti method. International Journal of Environmental Research and Public Health, 20(14), 6396.