DESCRIPTION and PREVALANCE
Also known as talipes equinovarus, this condition is present at birth: the babys foot is turned excessively downward (like a ballerinas pointy toes) but also rotated inward so that its soles face each other, or even upwards in some cases.
The condition occurs in one to three per thousand births, affects twice as many males as females, and in up to 50 percent of cases affect both feet.
There is some familial tendency seen where many members of the same family have the condition.
About 10 percent have other associated abnormalities.
In the majority of cases, it is an isolated finding in an otherwise normal baby. Of the rest, some are associated with other known chromosomal or neurologic abnormalities, such as:
- Down syndrome;
- spina bifida;
- anencephaly; or
Other possible causes relate to pregnancy, and include amniotic bands, early amniocentesis and uterine fibroids: these factors are thought to somehow impede the normal development and rotation of the foetal foot.
At birth, the deformity is usually so obvious that special tests are not needed. If other skeletal abnormalities are suspected, appropriate X-rays will be done.
Prenatal diagnosis is possible: club foot is often diagnosed at routine prenatal ultrasound examinations, but the severity of the problem cannot be predicted. Three-dimensional ultrasound gives very clear pictures of the deformity. In such cases, the baby must be fully screened for other abnormalities, or possible causes such as amniotic bands or uterine fibroids. If these are found, the parents may need counseling, for example about amniocentesis. A normal foetus can rotate its foot to look like a clubfoot, so it is vital that repeat scans be done to prove that it is not just a temporary position but a true deformity.
Treatment is begun as soon after birth as possible, and consists of gently manipulating the foot/feet back toward the normal position. To hold the position, the foot is placed in a cast. After a week, the cast is removed, the foot manipulated a little further toward a normal position, and then placed in a new cast. In this way, the foot is gently eased back into a normal position, with a new cast every week or so for about 10 weeks. A minor procedure, done under local anaesthetic, may be then required to incise the Achilles tendon. Once the correct position is achieved, a brace will need to be worn day and night by the baby for several weeks. Thereafter, it is worn at night only, for up to 4 years. This Ponseti method is highly successful.
In a few cases, the child may need a tendon transfer operation under general anaesthetic. This minor procedure corrects any muscle imbalance, and allows the development of a normal gait.
For isolated clubfoot, the outcome is excellent.
(Dr AG Hall, Health24, January 2008)