Clubfoot is a deformity of the whole foot that is present at birth. There are several types of clubfoot that are jointly known as 'talipes', as the deformity is mostly in the talus (a bone in the ankle). The most common of the talipes is what is known as "talipes equino varus" - it is so common that the word clubfoot is commonly used to refer to this. In talipes equino varus, the child is born with the foot pointing down and twisted inwards at the ankle.
The foot tends to be smaller than normal. Some children with clubfoot have stiffer joints in the foot and the calf muscles are usually smaller.
Clubfoot occurs in about 1 in 1000 births. Both males and females are equally affected. In half of the cases, both feet are usually affected.
Clubfoot must be treated, it does not correct itself.
There are two types of clubfoot.
The more severe type is usually associated with other abnormalities or problems such as spinal dysraphism, tethered cord, arthrogyrposis, etc
The second type of clubfoot is less severe and is often called "idiopathic" as the cause is not known. The clubfoot appearance at birth does resemble the position the foot is in during early fetal development, so it is assumed that some unknown cause halts the normal change of foot position during fetal growth.
What does clubfoot look like (talipes):
Clubfoot is usually noticed by the doctor at birth. The foot is turning inwards at the ankle and points down. The achilles tendon is tight. The front half of the foot is turned inward, giving the foot a kidney bean shape. If not corrected in infancy or if missed (not likely), the infant will walk on the outside of the foot and not be able to get the bottom of the foot flat on the ground. There maybe a decrease in size of the calf muscles and the affected foot may be smaller than the unaffected side.
What is the treatment for clubfoot (talipes):
All cases of clubfoot need treating - the earlier the better. Less severe and more flexible types are casted - the more severe and rigid types need surgery.
A series of plaster or fibreglass casts are applied to the foot and lower limb - these are replaced every few weeks, which each cast progressively moving the foot towards a more corrected position. The number of times the cast needs to be replaced will be determined by the severity of the clubfoot (but several months is not unusual). Most activities are not hampered by wearing a cast.
If cast treatment fails or the clubfoot is rigid, surgery may be needed. This is not usually done until the child is between four and eight months of age.
There are a variety of surgical procedures which may be done in isolation or in combination:
Soft tissue surgery that releases the tight tissues around the joints and results in lengthening of tendons so the foot can assume a more corrected position
Bony procedures such as "breaking bone" and resetting the bone to correct deformities, or fusing joints together to stabilize joints to enable the bones to grow solidly together.
Tendon transfers to move the tendons to a different position, so they can move the foot into a corrected position.
[Edited on 29/07/2008]
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