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Clubfoot is when the foot turns inward and downward. It is a congenital condition, whichmeans it is present at birth.

Causes

Clubfoot is the most common congenital disorder of the legs. It can range from mild andflexible to severe and rigid.

The cause is not known, but the condition may be passed down through families insome cases. Risk factors include a family history of the disorder and being male. Thecondition occurs in about 1 out of every 1,000 live births.

Symptoms

The physical appearance of the foot may vary. One or both feet may be affected.

The foot turns inward and downward at birth, and is difficult to place in the correctposition. The calf muscle and foot may be slightly smaller than normal.

Exams and Tests

The disorder is identified during a physical examination. A foot x-ray may be done.

Treatment

Treatment may involve moving the foot into the correct position and using a cast to keepit there. This is often done by an orthopedic specialist. Treatment should be started as

early as possible -- ideally, shortly after birth -- when reshaping the foot is easiest.

Gentle stretching and recasting occurs every week to improve the position of the foot.Generally, five to 10 casts are needed. The final cast remains in place for 3 weeks. After the foot is in the correct position, a special brace is worn nearly full time for 3 months.Then it is used at night and during naps for up to 3 years.

Often, a simple outpatient procedure is needed to release a tightened Achilles tendon.

Some severe cases of clubfoot will require surgery if other treatments do not work, or if the problem returns. The child should be monitored by a doctor until the foot is fully

grown. See: Clubfoot repair  

Outlook (Prognosis)

The outcome is usually good with treatment.

Possible Complications

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Some defects may not be completely fixed. However, treatment can improve theappearance and function of the foot. Treatment may be less successful if the clubfoot islinked to other birth disorders.

When to Contact a Medical Professional

If your child is being treated for clubfoot, call your health care provider if:

• The toes swell, bleed, or change color under the cast• The cast appears to be causing significant pain• The toes disappear into the cast• The cast slides off • The foot begins to turn in again after treatment

Alternative Names

Talipes equinovarus; Talipes

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Club foot

A clubfoot, or congenital talipes equinovarus (CTEV),[1] is a congenital deformity

involving one foot or both.[2] The affected foot appears rotated internally at the

ankle. TEV is classified into 2 groups: Postural TEV or Structural TEV. Without

treatment, persons afflicted often appear to walk on their ankles, or on the sides of their feet. It is a common birth defect, occurring in about one in every 1,000 live

births. Approximately 50% of cases of clubfoot are bilateral. In most cases it is an

isolated dysmelia. This occurs in males more often than in females by a ratio of 

Deformities

The deformities affecting joints of the foot occur at three joints of the foot to varyingdegrees. They are [2]

• Inversion at subtalar joint •

Adduction at talonavicular joint and• Equinus at ankle joint 

The deformities can be remembered using the mnemonic, "InAdEquate" for Inversion,Adduction and Equinus.[2]

[edit] Causes

There are different causes for clubfoot depending on what classification it is given.Structural TEV is caused by genetic factors such as Edwards syndrome, a geneticdefect with three copies of chromosome 18. Growth arrests at roughly 9 weeks and

compartment syndrome of the affected limb are also causes of Structural TEV. Geneticinfluences increase dramatically with family history. It was previously assumed thatpostural TEV could be caused by external influences in the final trimester such asintrauterine compression from oligohydramnios or from amniotic band syndrome.However, this is countered by findings that TEV does not occur more frequently thanusual when the intrauterine space is restricted.[3] Breech presentation is also another known cause.[citation needed ] TEV occurs with some frequency in Ehlers Danlos Syndrome and some other connective tissue disorders. TEV may be associated with other birthdefects such as spina bifida cystica.

[edit] Treatment

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Clubfoot is treated with manipulation by podiatrists, physiotherapists, orthopedicsurgeons, specialist Ponseti nurses, or orthotists by providing braces to hold the feet inorthodox positions, serial casting, or splints called knee ankle foot orthoses (KAFO).

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Other orthotic options include Dennis-Brown bars with straight last boots, ankle footorthoses and/or custom foot orthoses (CFO). In North America, manipulation is followedby serial casting, most often by the Ponseti Method. Foot manipulations usually beginwithin two weeks of birth. Even with successful treatment, when only one side isaffected, that foot may be smaller than the other, and often that calf, as well.

Extensive surgery of the soft tissue or bone is not usually necessary to treat clubfoot;however, there are two minimal surgeries that may be required:

1.  Tenotomy (needed in 80% of cases) is a release (clipping) of the Achillestendon - minor surgery- local anesthesia 

2. Anterior Tibial Tendon Transfer (needed in 20% of cases) - where the tendonis moved from the first ray (toe) to the third ray in order to release the inwardtraction on the foot.

Of course, each case is different, but in most cases extensive surgery is not needed totreat clubfoot. Extensive surgery may lead to scar tissue developing inside the child's

foot. The scarring may result in functional, growth and aesthetic problems in the footbecause the scarred tissue will interfere with the normal development of the appendage.A child who has extensive surgery may require on average two additional surgeries tocorrect the issues presented above.

In stretching and casting therapy the doctor changes the cast multiple times over a fewweeks, gradually stretching tendons until the foot is in the correct position of externalrotation. The heel cord is released (percutaneous tenotomy) and another cast is put on,which is removed after three weeks. To avoid relapse a corrective brace is worn for agradually reducing time until it is only at night up to four years of age.

[edit] Non-surgical treatment and the Ponseti Method

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but its sources remain unclear because it lacks inline citations.

Please improve this article by introducing more precise citations where

appropriate. (December 2009)

Main article: Ponseti Method 

Treatment for clubfoot should begin almost immediately to have the best chance for asuccessful outcome without the need for surgery. Over the past 10 to 15 years, more

and more success has been achieved in correcting clubfeet without the need for surgery. The clubfoot treatment method that is becoming the standard in the U.S. andworldwide is known as the Ponseti Method [4]. Foot manipulations differ subtly from theKite casting method which prevailed during the late 20th century. Although described byDr. Ignacio Ponseti in the 1950s, it did not reach a wider audience until it was re-popularized around 2000 by Dr. John Herzenberg in the USA and in Europe and Africaby NHS surgeon Steve Mannion while working in Africa. Parents of children withclubfeet using the Internet [5] also helped the Ponseti gain wider attention. The Ponseti

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method, if correctly done, is successful in >95% of cases [6] in correcting clubfeet usingnon- or minimal-surgical techniques. Typical clubfoot cases usually require 5 casts over 4 weeks. Atypical clubfeet and complex clubfeet may require a larger number of casts.Approximately 80% of infants require an Achilles tenotomy (microscopic incision in thetendon requiring only local anesthetic and no stitches) performed in a clinic toward the

end of the serial casting.

After correction has been achieved, maintenance of correction may require the full-time(23 hours per day) use of a splint—also known as a foot abduction brace (FAB)—onboth feet, regardless or whether the TEV is on one side or both, for several weeks after treatment. Part-time use of a brace (generally at night, usually 12 hours per day) isfrequently prescribed for up to 4 years. Without the parents' participation, the clubfootwill almost certainly recur, because the muscles around the foot can pull it back into theabnormal position. Approximately 20% of infants successfully treated with the Ponseticasting method may require a surgical tendon transfer after two years of age. While thisrequires a general anesthetic, it is a relatively minor surgery that corrects a persistent

muscle imbalance while avoiding disturbance to the joints of the foot.

The developer of the Ponseti Method, Dr Ignacio Ponseti, was still treating children withclubfeet (including complex/atypical clubfeet and failed treatment clubfeet) at theUniversity of Iowa Hospitals and Clinics well into his 90s. He was assisted by Dr JoseMorcuende, president of the Ponseti International Association.

The long-term outlook [7] for children who experienced the Ponseti Method treatment iscomparable to that of non-affected children.

Watch a Video on the Ponseti Method

Botox is also being used as an alternative to surgery. Botox is the trade name for Botulinum Toxin type A. a chemical that acts on the nerves that control the muscle. Itcauses some paralysis(weakening) of the muscle by preventing muscle contractions(tightening). As part of the treatment for clubfoot, Botox is injected into the child’s calf muscle. In about 1 week the Botox weakens the Achilles tendon. This allows the foot tobe turned into a normal position, over a period of 4–6 weeks, without surgery.

The weakness from a Botox injection usually lasts from 3–6 months. (Unlike surgery ithas no lasting effect). Most club feet can be corrected with just one Botox injection. It ispossible to do another if it is needed. There is no scar or lasting damage. BC Women

and Childrens Hospital

[edit] Surgical treatment

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Please help improve this article by adding reliable references. Unsourced material

may be challenged and removed. (December 2009)

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On occasion, stretching, casting and bracing are not enough to correct a baby'sclubfoot. Surgery may be needed to adjust the tendons, ligaments and joints in thefoot/ankle. Usually done at 9 to 12 months of age, surgery usually corrects all clubfootdeformities at the same time. After surgery, a cast holds the clubfoot still while it heals.It is still possible for the muscles in the child's foot to try to return to the clubfoot

position, and special shoes or braces will likely be used for up to a year or more after surgery. Surgery will likely result in a stiffer foot than nonsurgical treatment, particularlyover time.

Without any treatment, a child's clubfoot will result in severe functional disability,however with treatment, the child should have a nearly normal foot. He or she can runand play without pain and wear normal shoes. The corrected clubfoot will still not beperfect, however; a clubfoot usually stays 1 to 1½ sizes smaller and somewhat lessmobile than a normal foot. The calf muscles in a leg with a clubfoot will also staysmaller.

[edit] Famous people

 The club-foot, by José de Ribera.

Many notable people have been born with clubfoot, including the Roman emperor Claudius, Egyptian pharaoh Tutankhamun, statesman Prince Talleyrand, Civil War politician Thaddeus Stevens, the comedian Damon Wayans, actors Gary Burghoff ,Dudley Moore and Eric The Midget from The Howard Stern Show, footballer Steven

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Gerrard, sledge hockey player Matt Lloyd (Paralympian),mathematician Ben Greenberg,and filmmaker Jennifer Lynch (daughter of David Lynch).

British Romantic poet Lord Byron had a clubfoot, which caused him much humiliation.

Actor/musician/comedian Dudley Moore was born with a club foot. This was mostlyunknown to the public as he wore one shoe with a slightly bigger sole to compensatewhen walking.

Kristi Yamaguchi was born with a clubfoot, and went on to win figure skating gold in1992. Soccer star Mia Hamm was born with the condition. Baseball pitcher Larry Sherry was born with club feet, as was pitcher Jim Mecir , and both enjoyed long and successfulcareers. In fact, it was suggested in the book Moneyball that Mecir's club footcontributed to his success on the mound—it caused him to adopt a strange delivery that"put an especially violent spin" on his screwball, his specialty pitch. San FranciscoGiants (the team with the all-time most clubbed feet players) infielder Freddy Sanchez 

cites his ability to overcome the defect as a reason for his success.

[8]

 Tom Dempsey of the New Orleans Saints, born with a right club foot and no toes (this was his kickingfoot), kicked an NFL record 63 yard field goal. This kick is famous as the longestregular-season NFL kick in history(until 2009).

Nazi Propaganda Minister  Joseph Goebbels had a right clubfoot (possibly incurred after birth as a complication of osteomyelitis),[9] a fact hidden from the German public bycensorship. Because of this malformation, Goebbels needed to wear a leg brace. That,plus his short stature, led to his rejection for military service in World War I.

De Witt Clinton Fort was born with a clubfoot. De Witt Clinton Fort was known during the

American Civil War as Captain "Clubfoot" Fort, C.S.A..

Tutankhamun suffered from a club foot and a cleft palate and it is likely that he neededa cane to walk.[10]

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CLUB FOOT (CONGENITAL TALIPES EQUINOVARUS) 

INTRODUCTION

Clubfoot is a congenital foot condition, which affects approximately 1 out of every 1000 births in the United Kingdom. However, prevalence of thiscondition is twice as common in males than females. The deformity can bemild or severe and it can affect one foot or both feet. As many as 50% of cases are bilateral (both feet are affected). Club Foot is sometimes confused

with other congenital foot defects, such as Calcaneovalgus andMetatarsus

adductus. These deformities are caused by the position of the foot in the womband are usually corrected with minimal intervention. True clubfoot affects allthe joints, tendons and ligaments in the foot and is often referred to asCongenital Talipes EquinoVarus. Another form of clubfoot is CongenitalVertical Talus, this is not as common as true clubfoot, the foot appears morerigid then a true club foot deformity. In most cases, clubfoot is idiopathic,which means that the cause is unknown and there is no genetic tendency.However it is associated with Spina Bifida and Hip Dysplasia.

 

APPEARANCE

• High arched foot that may have a crease across the sole of the foot.• The heel is drawn up.• The toes are pointed down.• The bottom of the foot (heel) is pointed away from the body. Thus, the

foot is twisted in towards the other foot (please refer to photographbelow)

The above photograph is of a Clubfoot deformity in a new born child,

 

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• The foot and leg may be smaller in comparison to a comparativelynormal child.

• The foot will lack motion and be noticeably stiff.• The calf muscle may also be smaller.

SYMPTOMS

• If left untreated the child will walk on the outer top surface of the foot.• The patient may also experience corns, hard skin and in growing

toenails.• Clubfoot in adulthood can lead to difficulty in purchasing shoes and a

gait abnormality (walking pattern).

WHAT YOU SHOULD NOT DO

• DO NOT ignore this condition in a hope that it will spontaneouslydisappear.

WHAT YOU SHOULD DO

• Seek immediate advice from a pediatric consultant.• Seek as many opinions as you can before you commence a treatment

regime.

TREATMENTS

There are many treatments available for clubfoot and many different opinions

exist concerning treatment regimes.

The aim of the treatment regime should be: -

1. Correct the deformity early.2. Correct the deformity fully3. Hold the correction until growth stops.

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Below is the summary of some of the main conditions.

 

Casting

• This may be begin from the 1st day of life to several weeks after birth.• The foot is pushed and twisted into an over corrected position by the

Orthopedist. The cast is then applied in order to hold the foot into thatposition. This may be uncomfortable for the child.

• Casts are usually changed every two weeks.• Splints or braces may be used after a few years of casting the feet.

This above photo of an infant in a Denis Browne bracing bar after undergoingmonths of casting using the Ponseti method as treatment for his bilateral

clubfeet.He will have to wear the bracing bar for 23 hours a day for about 3 months

and then only at night for two to four years.

• The Ponseti method of casting and manipulation can also be effective.This method was pioneered in the 1940's by Dr Ignocio Ponseti and canbe successful in certain cases. Please refer to your consultant for further information.

Surgery

There are many surgical procedures available for clubfoot. Surgery is usuallyrecommended to a child of six months old. Below are the list of commonlyused surgical procedures. For further information concerning these surgicalprocedures, please consult an Orthopedist.

• Perctuneous tenotomy. The Achilles tendon is cut to allow the foot todrop.

• Posterior release.• Medial release.• Subtarsal release.• Complete tendon transfer.

Physiotherapy

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• This is primarily a non-surgical treatment that can begin when the childis three months old.

• It involves frequent visits by a physical therapist who tapes and/or manipulates the foot. This method has proved highly successful in somecases.

WHAT THE CHIROPODIST WILL DO

• Refer you to a pediatric consultant or a physical therapist.• In adulthood, the chiropodist will treat any foot conditions that may arise

due to clubfoot, i.e. Corns.• The chiropodist may customize insoles or shoes for the patient.

CONDITIONS THAT RESEMBLE A CLUB FOOT

• Calcaneovalgus• Metatarsus Adductus

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What is clubfoot (talipes):Clubfoot is a deformity of the whole foot that is present at birth. There are several types of clubfoot that are jointly known as

'talipes', as the deformity is mostly in the talus (a bone in the ankle). The most common of the talipes is what is known as "talipes

equino varus" - it is so common that the word clubfoot is commonly used to refer to this. In talipes equino varus, the child is born

with the foot pointing down and twisted inwards at the ankle.

The foot tends to besmaller than normal.Some children withclubfoot have stiffer joints in the foot andthe calf muscles areusually smaller.

Clubfoot occurs inabout 1 in 1000births. Both malesand females areequally affected. Inhalf of the cases,both feet are usuallyaffected.

Clubfoot must betreated, it does notcorrect itself.

 

Clubfoot causes:There are two types of clubfoot.

• The more severe type is usually associated with other abnormalities or problems such as spinal dysraphism, tethered

cord, arthrogyrposis, etc

• The second type of clubfoot is less severe and is often called "idiopathic" as the cause is not known. The clubfoot

appearance at birth does resemble the position the foot is in during early fetal development, so it is assumed that someunknown cause halts the normal change of foot position during fetal growth.

What does clubfoot look like (talipes):Clubfoot is usually noticed by the doctor at birth. The foot is turning inwards at the ankle and points down. The achilles tendon istight. The front half of the foot is turned inward, giving the foot a kidney bean shape. If not corrected in infancy or if missed (notlikely), the infant will walk on the outside of the foot and not be able to get the bottom of the foot flat on the ground. There maybea decrease in size of the calf muscles and the affected foot may be smaller than the unaffected side.

 

What is the treatment for clubfoot (talipes):All cases of clubfoot need treating - the earlier the better. Less severe and more flexible types are casted - the more severe andrigid types need surgery.

Casting

A series of plaster or fibreglass casts are applied to the foot and lower limb - these are replaced every few weeks, which each castprogressively moving the foot towards a more corrected position. The number of times the cast needs to be replaced will be

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determined by the severity of the clubfoot (but several months is not unusual). Most activities are not hampered by wearing a cast.

Surgery

If cast treatment fails or the clubfoot is rigid, surgery may be needed. This is not usually done until the child is between four andeight months of age.

There are a variety of surgical procedures which may be done in isolation or in combination:

• Soft tissue surgery that releases the tight tissues around the joints and results in lengthening of tendons so the foot can

assume a more corrected position

• Bony procedures such as "breaking bone" and resetting the bone to correct deformities, or fusing joints together to

stabilize joints to enable the bones to grow solidly together.

• Tendon transfers to move the tendons to a different position, so they can move the foot into a corrected position.