Clubfoot

This is a general term for several congenital foot malformations involving bones, muscles and tendons. The foot can be fixed in an abnormal position, flexed, extended, turned in, or turned out at the ankle, with toes lower or higher than the heel. Clubfoot may affect one or both feet and is twice as common in boys as in girls. Heredity is a factor in the development of the condition. Treatment begins shortly after birth and includes exercise, plaster casts and/or splints to manipulate the foot into a normal position. In some infants, surgical correction is required. With early treatment, children with clubfeet can grow up to walk and run normally.

WHAT CAUSES CLUBFOOT?
The cause of clubfoot is unknown, but there are several theories. During fetal development, the foot passes through a number of stages in which it is flexed and turned outward until it assumes its normal position, which should happen by the seventh month. If this developmental process is interrupted, the foot may remain frozen in one of these primitive positions, probably for genetic reasons. Restricted movement in the womb may also contribute to the development of clubfoot. Some doctors theorize that both genetic and environmental forces play a role in the development of this malformation.

Many mothers feel guilty about giving birth to a baby with a clubfoot, but occurrence of this deformity is beyond the parents' control. Nothing they did or failed to do causes clubfoot, and no measures can be taken to prevent the disorder.

IS MEDICAL ATTENTION NECESSARY?
Early treatment is critical, since rapid growth in infancy provides ample opportunities for remodeling the foot. In fact, the sooner treatment begins, the greater the chances that the child will eventually walk normally. Fortunately, clubfoot is usually apparent at birth, so treatment is often initiated within hours of the delivery. At this early stage, correction is much easier because the joints are very flexible and the infant's ligaments are particularly supple.

WHAT TREATMENTS ARE AVAILABLE?
In mild cases, treatment includes stretching exercises and special shoes or splints, but many babies require leg casts extending from feet to groin. The orthopedist manipulates the baby's feet into the closest possible approximation to a normal position and immobilizes them there with casts or adhesive taping. Manipulation and casting are repeated every few days for the first two weeks of the child's life and then at intervals of one to two months. When the deformity is fully corrected, the foot will be maintained in an overcorrected position for several weeks in a cast. Afterward, the baby may have to sleep for some time with the feet in a splint to prevent recurrence.

If manipulation does not correct the clubfoot, surgery is required, sometimes when the baby is only two to three months of age. It may involve releasing tight ligaments or lengthening tendons to place bones in a normal position. In infants and younger children, surgery is usually necessary only on soft tissues, not on bones. By the first year of life, a treated clubfoot may look almost normal, but because this disorder tends to recur, the child will require orthopedic care throughout childhood.

CARING FOR A CHILD WITH CLUBFOOT
Caring for a child with clubfoot requires a great deal of patience. Even after the deformity is corrected, the new position of the foot must be maintained until normal muscle balance develops to prevent recurrences. You will probably learn how to stretch and manipulate the baby's foot gently; many parents schedule regular exercises at feeding times in order to remember them.

In addition, adhere to the following guidelines for taking care of a child in a cast:

• Provide stimulating activities to support the infant's normal development as much as possible.

• Check the infant's toes for color, sensation and motion to be sure that the cast is not too tight.