Most children born with clubfoot have 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. For kids diagnosed with the condition, 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 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/Alfred I. duPont Hospital for Children are experts at diagnosing and treating children born with clubfoot. Our hospital is ranked among the best children’s hospitals in the country for orthopedics by U.S. News and World Report.
Our pediatric orthopedists also have been selected among the Best Doctors in America®, year after year. If your child has clubfoot, it may be seen on a standard prenatal ultrasound or will be visible immediately at birth. Smoking exposure may increase the risk of having a child born with clubfoot. We recommend contacting us as soon as the diagnosis is made.
At duPont Hospital for Children, your child will be treated 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 problems. Each child is photographed at the start of treatment. Your Nemours physician may also need to order other imaging tests such as an ultrasound, X-ray, CT scan, or MRI scan which are all available right at the hospital.
Most children with clubfoot do not have other medical problems, and the condition is treated on its own. The Ponseti method 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 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 will extend partially up the thigh. 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 will remain in place for up to 3 weeks. You’ll learn about bathing and caring for your child during this period.
In some cases, despite the gentle stretching that’s a hallmark of the Ponseti method to correct the foot, the Achilles tendon may be a little too tight. To correct this, your Nemours physician may need to make a small incision in the back of the foot and lengthen the Achilles tendon. The foot is then casted in the final corrected position. This nearly painless procedure might take place in the office or in the operating room at Nemours/Alfred I. duPont Hospital for Children and will heal in about 3 weeks.
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 during sleep. There are no restrictions on normal activities. Bracing may continue for up to 5 years. During this time the children are followed up frequently to watch for recurrence.
Some children 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 tibial anterior tendon to the middle of the foot
- lengthen the Achilles tendon
Your child may also be referred to a Physical Therapist at the hospital for exercises that can help stretch the foot and strengthen the muscles in the calf and foot. After 3 years of age, your doctor may recommend a gait lab analysis to study your child’s gait and foot pressures. Occasionally, X-rays are taken.
One in 1,000 children is born with congenital clubfoot. That possibility increases if the condition is present in your family’s history. Clubfoot 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 can play 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.