Clubfoot: Causes and treatments

Clubfoot refers to a condition in which a newborn’s foot or feet appear to be rotated internally at the ankle.

The foot points down and inwards, and the soles of the feet face each other.

It is known as talipes equinovarus (TEV) or congenital talipes equinovarus (CTEV). In 50 percent of cases, both feet are affected.

According to the National Institutes of Health (NIH), just over 1 in every 1,000 infants are born with clubfoot.

Symptoms

[Clubfoot - WikiCommons image <br>Image credit: OpenStax College, April 2013</br>]
Clubfoot is a congenital physical deformity.
Image credit: OpenStax College, April 2013

In clubfoot, the tendons on the inside of the leg are shortened, the bones have an unusual shape, and the Achilles tendon is tightened.

If left untreated, the person may appear to walk on their ankles or the sides of their feet.

In an infant born with clubfoot:

the top of the foot twists downwards and inwards

the arch is more pronounced and the heel turns inward

in severe cases, the foot may look as if it is upside-down

the calf muscles tend to be underdeveloped

if only one foot is affected, it is usually slightly shorter than the other, especially at the heel

A person with a clubfoot does not usually feel discomfort or pain when walking.

A health care professional normally notices a clubfoot when a baby is born. Sometimes it can be detected before birth.

Most children will have only a clubfoot and no other condition, but sometimes clubfoot occurs with other problems, such as spina bifida.

Risk factors for clubfoot

Risk factors for clubfoot include the following:

Gender: Males are twice as likely as females to be born with clubfoot.

Genetics: If a parent who was born with clubfoot, their children have a higher chance of having a child with the same condition. The risk is higher if both parents have the condition.

Researchers at Washington University School of Medicine in the United States traced the condition to a mutation in a gene critical for early development of lower limbs called PITX1.

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Causes

Clubfoot is mainly idiopathic, which means that the cause is unknown. Genetic factors are believed to play a major role, and some specific gene changes have been associated with it, but this is not yet well understood. It appears to be passed down through families.

It is not caused by the fetus’ position in the uterus.

Sometimes it may be linked to skeletal abnormalities, such as spina bifida cystica, or a developmental hip condition known as hip dysplasia, or developmental dysplasia of the hip (DHH).

It may be due to a disruption in a neuromuscular pathway, possibly in the brain, the spinal cord, a nerve, or a muscle.

Environmental factors may play a role. Research has found a link between the incidence of clubfoot and maternal age, as well as whether the mother smokes cigarettes, and if she has diabetes.

A link has also been noted between a higher chance of clubfoot and early amniocentesis, before 13 weeks of gestation during pregnancy.

Diagnosis

The condition is immediately visible at birth.

It can also be detected before birth by ultrasound, especially if both feet are affected. If it is detected before birth, no treatment is possible until after the baby is born.

Whether the condition is detected during pregnancy or after birth, doctors will recommend more tests to check for other health problems, such as spina bifida and muscular dystrophy.

X-rays may help to observe the deformity in more detail.

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Treatment

A clubfoot will not improve without treatment. Leaving the foot untreated increases the risk of complications later in life.

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