Symptoms and treatment of clubfoot

Description

Clubfoot describes a condition present at birth in which a baby's foot pointing inwards and downwards. The tissues that connect muscles to bones are called tendons. In clubfoot, the tendons are shorter than usual, pulling the feet out of position.

Also called congenital talipes equinovarus (TAL-ih-peez e-kwie-no-VAY-rus), clubfoot is a common foot condition. It can occur in up to 1 out of every 1,000 babies. The majority of infants born with clubfoot has no other medical conditions.

Clubfoot can be mild to severe. About half of children with clubfoot have it in both feet. If a child has clubfoot that is not treated, the child can walk on the side or top of the foot. This can cause lameness, sores on the skin or callus, and the problems that the use of shoes.

The clubfoot will not get better without treatment. But it can be successfully treated using a casting technique. Usually, the babies also need a minor procedure to lengthen the tendon of the heel. The results of the treatment are the best with the casting that begins within several weeks after birth.

Symptoms

If your child has clubfoot, here's what that might look like:

The top of the foot is usually pointing in and down. This raises the bow and becomes the heel towards the inside.
The foot can be brought back so severely that it seems that it is the other way around.
The foot or big toe of the foot may be slightly shorter than the other foot.
The muscles of the calf of the leg with clubfoot are generally smaller.

At birth, the clubfoot does not cause any pain or discomfort.

When to see a doctor

Your health care professional is likely to notice the clubfoot during an exam soon after the birth of your child. You may be referred to a doctor who specializes in bone and muscle conditions in children called a pediatric orthopedic surgeon.

Causes

The cause of clubfoot is not known, but may be due to genetic and environmental factors.

Risk factors

The boys are twice as likely as girls to have clubfoot.

The risk factors include:

The history of the family. If a child has a father, mother, brother or sister with the clubfoot, the child is more likely to have too.
Part of other conditions. Sometimes the clubfoot may occur with other disorders of the skeleton that are present at birth. An example is spina bifida, a condition that occurs when the spine and spinal cord fails to develop or close properly before birth. Certain conditions related to changes in the chromosomes may also increase the risk of clubfoot.
Environment. Smoking during pregnancy can increase the baby's risk of clubfoot.
There is not enough amniotic fluid during pregnancy. The amniotic fluid is the fluid that surrounds the baby in the womb. Not having sufficient amount of amniotic fluid may increase the risk of clubfoot.

Complications

Clubfoot usually does not cause any problem until the child begins to stand and walk. The treatment can put the foot in the correct position and help a child to walk. But a child may still have some problems with:

Movement. The foot may be a little stiff and does not bend easily.
The length of the legs. The leg with the clubfoot may be slightly shorter, but this usually doesn't leave a child learn to walk.
Shoe size. The distance can be up to 1 1/2 sizes smaller than the other foot.
Calf size. The calf muscles on the side with the clubfoot can be always smaller than those on the other side.
The shape of the foot. It is common for the foot to have a bean shape and a small inward point, even after treatment.

If the clubfoot is not treated, more serious problems can happen. These may include:

Problems with walking. When clubfoot is not treated, children with the condition can take a walk, but you can put your weight on the side of the foot or the top of the foot. This may cause sores or calluses, difficulty finding shoes, and a limp.
Problems with the delayed treatment. The delay in the treatment of clubfoot may result in the need of more casts and even surgery to correct the foot. The results are better with early treatment before the bones of the feet are deformed from the bad position of the foot.
Arthritis. There may be swelling and tenderness in one or more joints.
Poor self-image. The unusual appearance of the feet can make the image of the body in a concern during the years of adolescence.

Prevention

Because health professionals do not know what causes clubfoot, there is no sure way to prevent. But if you are pregnant, you can do things to have a healthy pregnancy and to reduce your baby's risk of problems that affect the development of the baby:

Do not smoke or spend time in places with second-hand smoke.
Do not drink alcohol.
Non-use of legal or illegal drugs that can be sold on the streets or taking drugs that are not approved by your health care professional.

Diagnosis

Many times, a professional of the health of the diagnosis of clubfoot soon after birth, only to see the shape and position of the newborn's foot. Sometimes x-rays are taken to fully understand how severe the clubfoot is. But generally, X-rays are not necessary.

Often, the clubfoot can be seen before birth, during a routine ultrasound examination at 20 weeks of pregnancy. While the condition can't be treated before birth, namely, the condition can give time to learn more about clubfoot. You will have time to talk with health experts, such as a pediatric orthopedic surgeon, to plan treatment. If necessary, a medical geneticist can talk with you about the results of genetic tests and the risk of having a baby with clubfoot in future pregnancies.

Treatment

Because a newborn, bones, joints, and tendons are very flexible, the treatment for clubfoot usually begins in the first week or two after birth. The goals of treatment are to move the child's foot in a corrected position with the bottom of the feet pointing to the ground. The treatment with the frame allows for better movement of the feet and better long-term results. The treatment is more effective if performed in the first few months of age.

The treatment options include:

The stretching and casting, called the Ponseti method.
The stretch, the immobilization and bandage, called the method of the French.
Surgery.

Casting: Ponseti method

The foundry is the main treatment for clubfoot. The professional of the health in general:

Moves of your baby, standing in a better position, and then placed in a mold to keep it there.
Resets and recasts your baby's feet once a week for several months.
Perform a minor procedure to lengthen the tendon of the heel, called the tendon of Achilles, towards the end of this process.

After the shape of the feet of your baby has been improved, the foot must remain in the position. To help your child keep the foot in position:

Put your child in special shoes and braces.
Make sure that your child wears the shoes and the supports as much time as needed. This is usually all day and all night for a 3 to 6 months, and then at night and during naps until your child is 3 to 4 years of age.

For this method to be successful, the keys must be used following the instructions exactly so that the foot does not return to its original position rotated. When the Ponseti casting approach is not working, the main reason is because the keys are not used as directed. If your child is not able to carry the keys or exceeds the keys, talk to your health care professional immediately.

Even with treatment, clubfoot may not be totally correctable. For some children, the foot may begin to rotate again. If this happens before the age of 2 years, may require more casting to get the foot in the correct position. But most of the time, babies who are treated in time grow to wear regular shoes without keys, participate in sports, and to lead a full and active life.

The stretch, the immobilization and dressing: French method

The French method was developed in France and is most often used only in France. It is a type of stretching treatment that is best for mild clubfoot. The foot is stretched into position, then taped and splinted each day. The method consists in frequent physical therapy appointments and daily treatments made by the parents until the child is 2 to 3 years of age. A minor procedure to lengthen the tendon of the heel, called the Achilles tendon, it is generally necessary.

Surgery

If a baby's clubfoot is not improved by the casting method, or if a child does not have complete correction later in life, surgery may be needed. Even with a successful outcome in children, surgery is sometimes needed about 3 to 5 years of age, if the child's foot continues to turn in. During the surgery, an orthopedic surgeon repositions the tendons to help keep the foot in a better position. This surgery is called a transfer of the tibialis anterior tendon, and has very good results.

Rarely severe clubfoot or clubfoot is a part of a syndrome or other underlying medical conditions, more extensive surgery may be needed in childhood. This surgery is called a posterior release or release posteromedial. This surgery relaxes the ligaments in the back and side of the ankle and may result in a greater correction of the foot. Even despite the fact that the foot is in a better position, the foot may become stiff and pain in the foot is more likely to be later in life.

After the surgery, the child is in a cast up to two months. Then the boy takes a stand for several years or so to keep the clubfoot of return.

Preparing for your appointment

If your baby is born with clubfoot, the condition is likely to be diagnosed during pregnancy or shortly after birth. Your baby's healthcare provider will likely refer you to a specialist in bones and muscles of the conditions in which the children is called a pediatric orthopedic surgeon.

If you have time before the meeting of your child's health care professional, to make a list of questions to ask. These may include:

Tends to treat infants born with clubfoot?
Should my child be referred to a specialist?
What types of treatment are available?
Does my child need surgery?
What type of follow-up care will my child need?
Should I get a second opinion before beginning treatment of my child? Will my insurance cover it?
After the treatment, will my child be able to walk well?
Do you have any information that could help me learn more? What websites do you suggest?

Feel free to ask questions during your appointment.

Also tell your health care professional if you:

Have the members of the family, including the extended family, who have clubfoot.
Has had problems during your pregnancy.

Be ready for your appointment you can give time to talk about what is most important to you.