FAQ: what is Clubfoot, what types are there, treatment options

From the B.C. Children's Hospital Literature - 2008

What is Clubfoot? Clubfoot, or "talipes equnovarus" is a condition where the foot turns inward and down in a fixed position. General stats indicate that it happens 1 in 1000 births and is more frequent in boys. Some ethnic groups have more common occurrences. Despite being documented from the ancient egypitans onwards, no specific causes or genes have been identified.

What are the types? There are three types of clubfoot. Though it can be picked up on ultrasound, doctors are unable to identify what types or severity until birth and live examination.

Positional Ultrasound: This types is caused by the foot being held in a curved position in utero. The bones and tendons of the foot are normal, and is easily corrected.

Teratologic Clubfoot: The muscles and tendons are not formed well and are often a part of neuromusclar disorders such as Spina Bifida or other conditions.

Idiopathic Clubfoot: For no known reason, the muscles and tendons fail to develop properly during the first three months of development in utero. It is more difficult to correct.

What is the Treatment:

Phase 1: Casting. Over the course of 4-10 weeks, a series of casts are placed. With each cast, stretches and manipulation of the foot are done to slowly move the foot into the correct position.
The cast goes from the knees to above the toes and is changed weekly. About 80% of cases do not need further casting.

Phase 2: Surgery/Botox: If the Achilles Tendon is still too tight, the a procedure is performed to cut the tendon and allow it to heal in a lengthed manner. During this time another cast in place. This cast remains on for about 3 weeks. Some clinics offer Botox as an alternative for select cases. It weakens the tendon enough to stretch out and also involves casting for another 4 weeks.

Phase 3: Maintence: A child's feet are in a constant state of growth. In order to prevent a relapse, children are fitted with a brace of boots attached to a bar in an over corrected position. It is worn until the age of 3 or 4. The child wears the boots and bar 23 hours per day until they can stand.

Once the child can stand, it's used for naps and sleeping, which works out 12-14 hours per day. Follow up appointments are then monthly. When the child can walk, naptime use is elimniated and night time use only remains in place until 3 or 4. Appointments are then every 3 - 6 months.

Regular 6 month follow up visits take place to ensure that no relapses take place. If regular follow up isn't conducted, a stiff foot becomes very difficult to treat, leaving surgery as the only option.