Clubfoot in children is most often a congenital (present at birth) abnormality that causes one or both feet to turn inward and downward. For the majority of children, clubfoot is almost completely correctable without major surgery or pain. Nemours orthopedic specialists use an established method to gently and safely stretch your child’s foot or feet into the correct forward-facing position using casts and, later, orthotics (braces).
Congenital clubfoot occurs in about one out of 1,000 children and is twice as common in boys as girls. With clubfoot in children, there’s an excellent chance that proper treatment will allow them to run, jump, play sports, dance, and experience all the joys of childhood.
The most effective and least expensive treatment for congenital clubfoot in chilldren is the Ponseti method. Named after Ignacio Ponseti, the doctor who invented it, this minimally invasive treatment is considered the international gold standard in correcting clubfoot. It starts shortly after birth and has two distinct phases:
- Casting: A cast is placed on the affected foot or feet to gently guide the bones, ligaments, and tendons toward the correct position. The cast is replaced and adjusted weekly for several weeks. Many children do require a minor procedure to help achieve the final corrected position of the foot.
- Orthotics: After the final cast, they’ll be fitted for an orthotic, which keeps the clubfoot from developing again. The orthotic is used for a period of 2 to 5 years, mostly at night.
The Ponseti method has been developed and refined over the past 50 years, and numerous studies have shown that it’s almost always the most effective and least painful way to correct a clubfoot. It doesn’t cure clubfoot entirely, and the affected feet and calf muscles are usually a little smaller than normal. But the method does restore your child’s ability to enjoy all the physical activities of a normal childhood.
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The orthopedic specialists at Nemours Children’s Specialty Care, Jacksonville, are experts at diagnosing and treating congenital and other forms of clubfoot in children. If your child has clubfoot, it will be detectable in a standard prenatal ultrasound or will be visible immediately at birth. We recommend contacting us as soon as the diagnosis is made.
At Nemours Children’s Specialty Care, Jacksonville, the orthopedic physician who treats clubfoot in children is approved by the Ponseti Institute. This distinction is your assurance that your child’s care will comply with the Ponseti method, the most widely accepted treatment regimen for clubfoot. Your first visit will include a careful examination to determine if your child has any other medical factors. We may need an ultrasound or x-ray (both available at our clinic) or CT scan, MRI scan, or other imaging procedure, available through our nearby partner, Wolfson Children’s Hospital.
Most children with clubfoot do not have complications, and the condition is treated on its own, nearly always using a minimally invasive procedure that corrects the malformation gently over time and without significant pain.
For a small number of children, clubfoot can occur with other conditions, including:
If this is the case, your Nemours physician will work with other specialists at the clinic and hospital to coordinate treatment for all conditions in a way that gives your child the best chance for an active, healthy childhood.
Starting within weeks after birth and using techniques refined over decades, your Nemours specialist will begin easing your child’s foot gently into the correct position with a cast that may extend partially up the leg. The casting process, repeated approximately every week, is nearly painless and usually takes less than 30 minutes. This regimen usually lasts between 4 and 9 weeks; the final cast may remain in place for up to 3 weeks. You’ll learn about bathing and caring for your child during this period.
Following the casting period, your child will be fitted for an orthotic (brace), which continues the gentle stretching process. You’ll receive detailed instructions on how and when to use the brace. To make the most of your child’s chance for successful treatment, it’s important to follow these instructions exactly as presented, without modifying or adapting them. Always call with any questions before making any adjustments.
At first, the brace stays on almost constantly and is removed only for bathing. After a few months, before your child starts crawling or walking, the brace is worn only at night. There are no restrictions on normal activities. Bracing may continue for up to 5 years.
The brace for your child may be provided at our clinic, or you may receive a prescription and help from our staff connecting with a provider that can supply it to you.
In some cases, the gentle stretching that’s a hallmark of the Ponseti method may leave your child with an Achilles tendon that’s a little too tight. To correct this, your Nemours physician may need to make a small incision in the back of the foot to help the tendon grow correctly. This nearly painless procedure might take place in the office or in the Operating Room at the hospital and will heal in a few weeks.
Some children between the ages of 3 and 5 might experience a partial relapse of clubfoot. If this is the case, your Nemours physician may need to:
- do additional casting to re-correct the position of the foot
- perform a procedure to transfer the anterior tibialis tendon to the middle of the foot
- lengthen the Achilles tendon
Your child may also be referred to a Physical Therapist for exercises that can help strengthen the muscles in the calf and foot and relieve any minor discomfort as your child grows.
One in 1,000 children is born with congenital clubfoot. That possibility increases if the condition is present in your family’s history. Clubfoot in children occurs about twice as often in boys as girls. If you have one child with clubfoot, there’s a greater chance that the condition will occur in
- additional children with the same parents
- children born to your child with clubfoot
- children born to your child’s siblings
Because genetics plays a role in determining who is born with clubfoot, your Nemours physician may also suggest a visit with a geneticist, who can provide guidance on the chances that you or your children will have children with the same condition.