Clubfoot (talipes equinovarus) is a congenital deformity of the foot, affecting the bones, muscles, tendons and blood vessels, and causing it to orient downard and inward. It affects around 1 in every 1000 newborns.
Clubfoot is characterised by deformity of the foot. It is not typically painful in very young infants, though if left untreated can be extremely uncomfortable, particularly when walking.
In patients with clubfoot, the achilles tendon, which connects the calf muscle to the heel can be tight, making it difficult to place the heel flat; patients may also exhibit a high arch (cavus foot), as well as muscle weakness.
The cause of clubfoot is not fully understood. However, it is thought to result from a combination of genetic factors and conditions during pregnancy, including unfavourable positioning in the womb and a reduced level of amniotic fluid.
Smoking during pregnancy has been linked to an increased risk of clubfoot, as has in utero exposure to drugs, alcohol and certain toxins. Rarely, clubfoot may occur without any clear cause.
Non-surgical therapies for clubfoot can be highly effective, particularly with early intervention. These include:
Ponseti method: The Ponseti method involves successive episodes of manipulation and casting to restore the foot into a normal position over time. This process is typically complemented by a long maintainence phase in which an orthotic brace is worn to maintain the correction for a period of several years, with decreasing frequency over time.
Even with consistent bracing, some children might experience occasional relapses. If the foot slides out of the orthotic regularly, it could signal a minor relapse in the condition. In such cases, prompt intervention often restores the desired outcome through serial casting or, in rare instances, minor surgery.
French method: less common than the Ponseti method, this involves the daily manipulation and taping of the foot by a physiotherapist over a period of years. As with the Ponseti method, a splint or brace may be used to maintain the correction.
In most cases, clubfoot can be corrected without surgical intervention. Where this is not possible, there are a number of surgical procedures which can allow for normal foot function and appearance. These include:
Soft tissue release (posteromedial release): this can involve lengthening of the achilles tendon, and release or lengthening of the joint capsules and ligaments of the foot and ankle, followed by manipulation of the foot into normal alignment and casting during healing. In some cases, tendon transfer can be done to improve muscle balance and foot position.
Osteotomy: in severe cases of clubfoot, the bones themselves may be malformed or misaligned. Osteotomy, which involves the cutting and realignment of bone to improve the overall structure of the foot, can be beneficial.
Joint fusion (arthrodesis): for recurrent or untreated clubfoot in older children and adults, fusion of the joints of the foot (talonavicular, subtalar and calceneoucuboid) can help to stabilise the foot and improve mobility.
For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.