Overview

Club foot, medically known as congenital talipes equinovarus (CTEV), is a common congenital condition where a newborn's foot or feet appear twisted out of shape or position. The foot usually points downward and inward, making walking difficult if left untreated. Club foot can affect one or both feet and occurs more frequently in males than females. Although the condition is present at birth, early treatment allows most children to achieve normal or near-normal foot function.

Causes

The exact cause of club foot is not fully understood, but several contributing factors have been identified:

• Genetic factors: A family history of club foot increases the likelihood of occurrence, suggesting a genetic link.
• Neuromuscular abnormalities: Conditions like spina bifida that affect the nervous system can lead to abnormal foot positioning.
• Intrauterine factors: Restricted space in the womb during pregnancy may contribute to improper foot development.
• Environmental factors: Smoking during pregnancy, certain infections, or drug use may slightly increase the risk.
• Idiopathic: In most cases, no specific cause is identified, and the condition develops spontaneously during fetal development.

Symptoms

Club foot is usually easy to recognize at birth with the following characteristics:

• Twisted foot: The foot appears rotated inward and downward, resembling the shape of a golf club.
• Rigid positioning: The foot may be stiff and resistant to gentle movement or repositioning.
• Underdeveloped calf muscles: The affected leg may have smaller or thinner calf muscles compared to the other leg.
• Shortened foot length: The affected foot is typically smaller than average.
• Abnormal walking patterns: If untreated, children may walk on the sides or tops of their feet rather than the soles.

Diagnosis

Club foot is usually diagnosed shortly after birth or even before birth through prenatal imaging:

• Physical examination: Doctors visually assess the shape and flexibility of the baby’s foot after delivery.
• Prenatal ultrasound: Club foot can often be detected as early as 20 weeks gestation during routine prenatal scans.
• X-rays: Rarely used in newborns, but may be helpful to assess bone alignment during treatment follow-ups.
• Neurological examination: In some cases, doctors may examine for related conditions like spina bifida.

Treatment

Treatment for club foot typically starts soon after birth, with excellent success rates when handled early:

• Ponseti method: The most widely used approach, involving gentle manipulation and casting to gradually correct the foot position, followed by a minor procedure called Achilles tenotomy and bracing.
• French method: Daily stretching, taping, and physiotherapy performed by trained specialists during early infancy.
• Bracing: After correction with casts, braces (foot abduction braces) are used for several years to prevent relapse.
• Surgery: In severe or resistant cases, surgical intervention may be needed to release tight tendons and correct deformities.
• Physical therapy: Ongoing exercises and therapy help maintain flexibility and strength in the corrected foot.

Prognosis

The prognosis for children with club foot is generally very good with timely treatment:

• High success rate: Most children treated early with methods like the Ponseti technique develop normal or near-normal foot function.
• Normal activity levels: Children can typically run, play sports, and participate in normal activities.
• Possible relapses: Some children may experience recurrence and require further treatment or prolonged use of braces.
• Untreated cases: Without treatment, club foot can lead to significant disability, pain, and difficulty walking.
• Overall outcome: With proper care, long-term outlook is excellent, and most children lead active, healthy lives.

Early diagnosis and intervention are key to ensuring the best possible outcome for children with club foot, helping them achieve good mobility and quality of life.