Clubfoot, medically known as congenital talipes equinovarus (CTEV), is a condition where infants are born with one or both feet twisted out of their normal alignment or position. It manifests in two ways: the most common is idiopathic clubfoot, which has no known cause, while the other is syndromic clubfoot, which co-exists with other medical disorders or genetic abnormalities.
Most babies with clubfoot see significant improvements in foot function and mobility with appropriate treatment. “Early intervention is the key in treating clubfoot,” says Dr Bharath N, junior consultant, neonatology, DHEE Hospitals, Bangalore. “It can be detected early through prenatal scans. However, only after the baby is born — ideally, one to two weeks after birth — can the treatment start.” When detected prenatally, parents can plan the appropriate treatment after their child is born. Otherwise, clubfoot is usually diagnosed during one of the first physical checks after birth.
What are the potential causes of clubfoot?
According to Dr Venugopal T, consultant orthopedic surgeon, DHEE Hospitals, Bangalore, about 50% of infants with clubfoot have it in both feet. The reason their feet twist inward is that their legs have tendons that are shorter and tighter than normal.
Speaking about the factors that make an infant susceptible to the condition, Dr Venugopal says, “Infants are more likely to have clubfoot if they are born with birth defects like cerebral palsy, spina bifida or genetic conditions like Edwards syndrome. Additionally, if a mother had oligohydramnios [reduced volume of amniotic fluid surrounding the fetus in the womb] or if she smoked, consumed alcohol or used recreational drugs during her pregnancy, her child might be more likely to have clubfoot.”
Treatment for clubfoot
Since the bones of an infant are better suited for manipulation during the growing stage, experts advise starting treatment at the earliest so that the child can develop a regular gait over time. “The first step in the treatment is to carefully stretch and manipulate the foot to gradually realign it. This is followed by Ponseti casting to keep the foot in the right position for a few weeks; the casts are replaced every one to two weeks,” explains Dr Venugopal.
“To keep the foot in the corrected posture and avoid recurrence, the child might have to put on special boots that contain a bar for a few months after casting. After that, the same should be done only at night for several years,” he adds.
Most cases of clubfoot are treated with this technique. However, in some situations — when other treatments fail or the condition is severe — surgery is needed, where the bones of the foot are aligned or the constricted tendons and ligaments are released.
Advice to parents
Even though most treatments are effective, there may be cases of recurrence resulting from unproductive intervention or any other underlying causes. “Parents often believe that after early intervention and treatment, further problems will not arise. However, in certain cases, the condition may return even after the treatment,” says Dr Bharath.
Suggesting some measures to minimize the recurrence rate, he says, “Non-compliance to treatment is the most common cause for recurring cases of clubfoot. I would advise parents to be consistent with the treatment and have regular follow-ups as per the advice of the doctor. Also, be patient with the process, considering that full recovery from the condition may take years.”
Takeaways
- Clubfoot refers to a condition where a baby is born with one or both feet shifted out of position. It can be idiopathic (without a known cause) or syndromic (co-existing with other conditions).
- Infants born with birth defects or genetic conditions are more likely to have clubfoot. Additionally, mothers engaged in smoking, drinking and recreational drugs during pregnancy are also likely to give birth to babies with the condition.
- Treatment for clubfoot includes stretching, manipulation, casting and bracing; some cases may also require surgery. Early intervention is essential for best results.
- It’s crucial for parents to stick with the treatment and ensure regular follow-ups to prevent recurrence.
