Clubfoot is a congenital deformity, i.e.
present at birth. It affects the foot and/or ankle. In
patients with clubfoot, the bones, joints, blood vessels,
and muscles in the foot are formed incorrectly. This results
in either mild or severe deformities. Most notable is the
`kidney shape' of the foot. It can affect one or both feet,
more frequently the left. In about half of the cases, both
feet are affected.
Clubfoot can occur by itself or it can be accompanied by
other birth defects such as malformation syndromes or
chromosomal syndromes.
There are three types of clubfoot:
Calcaneal Valgus
There is an angling of the foot at the heel. When this
occurs, the top of the foot looks as if it is bent to the
side and the toes point up and out.
Matatarusus Varus
In this the front of the foot is turned inwards.
Talipes Equinovarus
Here the foot is turned inwards and down.
In clubfoot, each child is likely to have
some of each of the following:
Plantar flexion: this refers to the twisting of the
ankle which causes the heel to be drawn up.
Cavus foot deformity: this refers to the high arch of
the foot. In some cases a high arch is very noticeable. In
other cases, because of the angling of the foot, the height
may be difficult to determine. In these cases, a crosswise
crease on the sole of the foot may be a good indication.
Varus: this refers to the inversion of the heel which
causes the front of the foot to turn inward
Adduction of the forefoot: this refers to amount the
forefoot is pulled downward
What is the cause?
There is no one known cause for
clubfoot. It may happen in the womb due to cramping or
twisting, somewhere around the 10th-12th weeks of pregnancy.
Some believe that heredity or other factors known to cause
birth defects may be to blame. These include use of drugs or
alcohol, or experiencing certain diseases.
There are some diseases such as myelomeningocele and
constriction band syndrome that may lead to clubfoot. Twice
as many boys as girls have clubfoot and heredity may be a
factor. If one child has it, there is a 3% to 4% chance a
sibling may have it too. And, if one parent and one child
have it, the odds increase to a 25% chance of a second child
having it.
What are the symptoms?
Noticeable deformity in the foot
Stiffness in the ankle or in foot tendons
The calf appears shorter than the other
leg (in cases where only one foot is affected)
Foot or feet turned or twisted awkwardly
Affected foot lacks the normal range of
motion
What is the diagnosis?
The disorder is identified
during a physical examination. A foot X-ray may be
performed.
What is the treatment?
It is important to treat
clubfoot as soon as it is diagnosed to avoid later problems.
With proper and professional treatment, clubfoot does not
represent a long-term disability or handicap. In many cases,
it can be corrected within about six to eight weeks by
exercise, manipulation and stretching of the heel cord, and
casting. Chances of correction are optimal during the first
two weeks of life, when the tissues and ligaments are very
elastic-like and pliable. The treatment should begin as
early as possible - ideally, just after birth when the foot
is easiest to reshape.
In more severe cases of clubfoot, surgery may be required to
lengthen the heel cord. The forefoot correction and hind
foot correction take more time and the heel cord lengthening
can be left until the child is older. Surgery can be
accompanied by scarring, stiffness and muscle weakness that
can become disabling in later years. If passive treatment of
the condition, such as using stretching or casting or both,
is used, it is important to have the foot evaluated
periodically. There is a tendency for clubfoot to relapse
because of growth. This is true particularly in the first
two or three years of life, although it is possible it may
happen even up to age 7. Splints are used after the last
cast comes off to help prevent the clubfoot from
reappearing. The splints must be worn full-time for several
months, and then nightly for the following two to four
years.
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