Club Foot Disease

Club foot is a prevalent congenital condition, affecting approximately 1 in every 1,000 newborns worldwide. This condition causes a baby's foot to turn inward & downward, making it one of the most common congenital disabilities affecting the musculoskeletal system. Understanding and managing Club foot is crucial to ensure proper growth and development in affected infants. 

What is Club Foot? 

Club foot, or congenital talipes equinovarus, is a complex deformity present at birth. It causes an infant's foot to turn inward and downward, often so severely that the bottom of the child's foot becomes sideways or even upward. In Club foot, the tendons connecting the leg muscles to the foot bones are shorter and tighter than usual, resulting in the characteristic twisted appearance. 

Club foot Types 

Club foot, a congenital deformity affecting infants, has various types: 

• Idiopathic Club Foot: The most common form is idiopathic club foot, which occurs without a known cause. This type affects one in every 1,000 babies, with boys being twice as likely to have it as girls. 
• Neurogenic Club Foot: This club foot condition is caused by underlying neurological conditions such as spina bifida or cerebral palsy. 
• Syndromic Club Foot: This type of club foot is associated with other syndromes-related clinical conditions like arthrogryposis or diastrophic dwarfism. 

Symptoms of Club foot 

Club foot disease has distinct symptoms that are noticeable at birth, such as: 

• The affected foot turns inward, facing the opposite leg, and has a kidney-like shape with a deep crease on the inside. 
• A higher arch than average, known as cavus foot deformity, is also present. The foot appears sideways or upside down, with toes pointing downward and backwards. 
• The Achilles tendon behind the ankle is tight, limiting the foot's range of motion. 
• In unilateral cases, the affected foot is often smaller, and the calf muscle may be underdeveloped. 

Club foot Causes 

• The exact cause of club foot disease remains unclear, but researchers believe it results from genetic and environmental factors. 
• Genetic influences play a significant role, as evidenced by the 33% concordance rate in identical twins and the fact that nearly 25% of cases are familial. 
• Environmental factors (maternal smoking during pregnancy & exposure to certain viruses) may also contribute to the development of Club foot. 

Risk Factors 

Several factors increase the likelihood of club foot disease in infants. 

• Boys are twice as likely to develop Club foot compared to girls. 
• A family history of the condition also raises the risk. 
• Babies with other congenital disabilities, such as spina bifida or cerebral palsy, are more susceptible. 
• Genetic conditions like Trisomy 18 (Edward syndrome) can contribute to Club foot development. 
• Maternal factors during pregnancy play a role, too. Insufficient amniotic fluid (oligohydramnios) and Zika virus infection can increase risk. 

Complications 

Club foot disease can lead to various complications if left untreated, such as: 

• Children may experience walking problems, often stepping on the sides or tops of their feet instead of the soles. This unusual gait can result in foot infections, calluses, and arthritis. 
• Untreated Club foot may cause one foot to be smaller and less mobile than the other, with underdeveloped calf muscles in the affected leg. 
• Patients might tire more quickly or complain of sore legs. 
• Even with club foot treatment, some individuals may face residual deformities, pain, and limited function in adolescence and young adulthood. These issues can include heel varus, forefoot adduction, and ankle impingement. 

Diagnosis of Club foot 

Doctors diagnose club foot disease through various methods. 

• Prenatal ultrasonography can detect Club foot as early as 13 weeks gestation using transvaginal techniques or at 16 weeks with transabdominal scans. Most often, the diagnosis occurs during routine ultrasounds at 20 weeks. 
• After birth, a thorough physical examination is crucial. Doctors assess the foot's shape, position, and flexibility. They move the foot back and forth to evaluate bone positioning and connective tissue tightness. 
• A comprehensive examination also helps rule out associated conditions like spina bifida or arthrogryposis. 
• In some cases, X-rays may be used to examine bone structure closely. 

Club foot Treatment 

• Ponseti Technique: The Ponseti method has become one of the most preferred treatment modalities for club foot disease. This technique involves a series of gentle manipulations and castings, typically starting within the first few weeks of life. The process begins with weekly cast changes, gradually correcting the foot's position. Most infants require 5 to 7 casts over several weeks or months. With proper implementation, the Ponseti method has a success rate of approximately 90%, allowing children to walk, run, and play without pain. 
• Achilles Tenotomy: In about 90% of cases, a minor procedure called an Achilles tenotomy is necessary to lengthen the heel cord. Following casting, the child wears a foot abduction orthosis to maintain the correction. This brace is worn full-time for about three months, then during sleep until age five. Adhering to the bracing regimen is crucial to prevent recurrence. 

When to See a Doctor 

Parents should contact their child's doctor if they notice any issues with the cast, such as it becoming soiled, wet, or dented. It's also important to seek medical attention if the baby's toes are not pink and warm or if the infant cries more than usual or appears in pain. A fever over 101°F after surgery requires immediate medical attention. 

Prevention 

While preventing all cases of club foot disease may not be possible, certain precautions can help reduce the risk, such as: 

• Expectant mothers play a crucial role in prevention. Avoiding smoking, alcohol, and unapproved drugs during pregnancy is essential, as these substances can affect the baby's growth and development. 
• Before conception, a preconception check-up and genetic counselling can be beneficial. 
• During pregnancy, attending all prenatal care appointments is vital. Protecting against Zika virus infection is also important. 
• By taking these steps, parents can give their children the best chance for a healthy start in life and potentially reduce the risk of Club foot. 

Conclusion 

Club foot disease presents significant challenges for affected infants and their families, but modern treatment methods offer hope for positive outcomes. The Ponseti method is preferred in managing this condition, with a success rate of around 90%. Combining gentle manipulations, casting, and bracing allows most children to walk, run, and play without pain. Early diagnosis & prompt treatment are vital in achieving the best results, highlighting the importance of regular prenatal check-ups and newborn examinations. 

FAQ's 

1. What is the leading cause of Club foot? 

The exact cause of club foot disease remains unknown. It is believed to result from a combination of genetic & environmental factors. Maternal smoking, diabetes, and alcohol consumption during pregnancy may contribute. 

2. Can Club foot recur after treatment? 

Yes, Club foot can recur after treatment. Recurrence is the most common complication, primarily due to non-compliance with the foot abduction orthosis during maintenance. 

3. Are there any long-term effects of having Club foot? 

Long-term effects of club foot disease may include: 

• Slightly less flexible foot 
• Shorter affected leg 
• Smaller shoe size for the affected foot 
• Smaller calf muscles on the affected side 
• Potential for arthritis 
• Possible body image concerns during teenage years 

4. Can a club foot be corrected? 

Yes, club foot disease can be corrected. The Ponseti method has become the most widely practised technique for early treatment of infants with Club foot. 

5. Is Club foot serious? 

Club foot is a severe condition that requires prompt treatment. If left untreated, it can lead to significant walking difficulties and long-term complications. 

6. When do Club foot babies walk? 

Babies with club foot disease may experience a slight delay in walking compared to those without the condition. On average, infants treated for Club foot begin walking independently at around 14.5 months, approximately two months later than infants without Club foot. By 18 months, 90% of treated patients typically walk without assistance. 

7. What age is Club foot surgery for? 

Surgery for club foot disease is typically considered when conservative treatments, such as the Ponseti method, have not been successful. The age for surgery can vary depending on the condition's severity and the child's specific needs. 

8. Is Club foot normal in newborns? 

Club foot is not considered normal in newborns but is a relatively common congenital condition. It occurs in approximately 1 in every 1,000 live births, making it one of the more frequent congenital foot deformities. 

9. Is Club foot curable permanently? 

While club foot disease can be effectively treated, it is essential to note that there is always a risk of recurrence, especially in the first few years of life. 

Dr. Shubham Chandrakant Padmawar

MBBS, MS
Ganga CARE Hospital Limited, Nagpur

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