Definition: A type of structural deformity of the foot
present at birth.
1. What caused this condition to occur?
“Clubfoot” is a term that describes a complex, abnormal structural
alignment of the bones and joints of the foot and ankle. It most likely
represents abnormal development of many tissue types below the
knee. The exact cause of clubfoot is still debated. It is likely caused by
multiple factors, including genetic and environmental factors.
Proposed theories of the cause of clubfoot include molding of the foot
while still in the womb (in utero molding), primary muscle problems,
primary bone deformity, primary blood vessel lesion, intrauterine viral
infection, primary nerve lesion, and abnormal stiffening of the tissues.
The actual cause is likely a combination of these factors.
2. What exactly is structurally wrong with the foot?
The appearance of clubfeet are created by both the malalignment of
the bones at the joints and the altered shape of the bones. In addition, the muscles, ligaments, tendons, and connective tissue (fascia) of the
foot and ankle are contracted, or shortened. The result is a rigid foot
that is turned downward and inward.
3. How is it treated, and how successful is the treatment?
The goal of treatment is a painless, flexible foot that strikes the
ground in proper position when walking. Regardless of the severity or
rigidity, the initial treatment is nonoperative, using repeated sequen-
tial castings, also called “serial castings.” The goal of this kind of treat-
ment is to limit the amount of surgery required.
Nonoperative treatment involves weekly serial castings to promote
gradual correction of the foot over six to eight weeks. Following this
casting regimen, nearly all children require a short outpatient surgical
procedure to fully correct the foot. Then a special brace is worn full
time for eight to nine months and part time for two to three years. The ability to completely correct the clubfoot deformity depends on
each child’s unique initial severity and rigidity, the age at which treat-
ment is started, the skill of the orthopedic surgeon, and the definition
of complete correction. Although the position of the foot may be
dramatically improved with treatment, nearly all patients with clubfoot
have a difference in calf size, foot size, and possibly overall limb length
compared to unaffected limbs. Eighty percent of children have a pain-
less functional foot following serial manipulation and casting.
4. Will my child be able to walk and exercise
normally following treatment?
Most children who undergo successful nonoperative treatment are
able to walk normally. Because this is an abnormality of most of the
tissues below the knee, some difference between normal limbs will always be observed. In a fully corrected foot, light exercise is generally well tolerated.
5. Do you think that there will be any limitations or
disadvantages athletically because of this condition?
Again, the goal of nonoperative treatment is a painless, supple, prop-
erly positioned foot. Generally, there is some residual stiffness and
weakness compared to normal limbs. Depending on the initial severity
and degree of correction achieved and maintained, there will likely be some degree of limitation athletically.
6. When do we need to see an orthopedic surgeon?
Consultation with a pediatric orthopedic surgeon should take place
when the diagnosis is made. Serial manipulation and casting should be
initiated as early as possible, preferably within the first week of life.
7. After discharge from the hospital, what kind of
follow-up will be needed for this condition?
If consultation with your pediatric orthopedic surgeon did not occur
prior to discharge from the hospital, your child should be seen in the
office in the first week of life. Weekly follow-up visits for manipulation and casting will be necessary for the first six to eight weeks.
Periodic follow-up will be necessary throughout childhood.
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