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Clubfoot is one of the most common non-major birth defects. At birth, the newborn’s foot (one or both) appears twisted inwards. Clubfoot is not painful and is correctable. Approximately 1 in every 1,000 newborns in the US has clubfoot, and 1/3 of those will be born with both feet clubbed. The cause of this condition is unknown. It tends to be more common in boys, although girls are not exempt.

If left untreated, the deformity does not go away. It gets worse over time, with bone changes developing over years. An uncorrected clubfoot is very unsightly and crippling. The patient walks on the outside of his foot which is not meant for weight-bearing. The skin breaks down, and develops chronic ulceration and infection.

Treatment should be started right away. The goal is to make the newborn’s clubfoot functional, painless and stable by the time he or she is ready to walk. The initial treatment consists of manipulating the foot to get it to the best position possible, and then holding the correction in a cast. The cast is changed on a weekly basis, with manipulation before each casting, to obtain further correction. After the first 6 weeks, the foot is manipulated and casted every 2 weeks.

In 50% of cases, clubfoot straightens with casting. If it does, the child will be fitted with special shoes or braces to keep the foot straight once corrected. These holding devices are usually needed until the child has been walking for up to a year or more.

When casting and stretching are not enough, surgery may be needed to adjust the tendons, ligaments, and joints in the foot/ankle. It is usually done at 6-12 months of age. Often, only one procedure is necessary. After surgery, another cast holds the clubfoot together while it heals.

If the clubfoot is not treated, the child will have a severe functioning disability. Treatment restores nearly normal foot, such that the child is pain-free and can run, play and wear normal shoes. However, you should expect the corrected clubfoot to stay 1 to 1 1/2 sizes smaller and somewhat less mobile than the normal foot.

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