Clubfoot in Children: Causes and Treatment

Clubfoot, medically known as congenital talipes equinovarus (CTEV), is a congenital deformity of the foot and ankle. The foot is twisted inward and downward, with the toes pointing toward the ground and the sole facing inward. It is a condition which may affect one foot or both.

The exact cause of clubfoot is still unknown, but it is believed to result from several factors, including:

• Genetics (risk is higher if there is a family history).
• Environmental factors (such as taking certain medications during pregnancy, intrauterine infection, or low amniotic fluid).
• Abnormalities in the muscles or tendons, which grow abnormally.

Clubfoot can be divided into two main types:

• Pseudo clubfoot: This condition is caused by abnormal positioning of the foot in the womb and is not a congenital structural abnormality of the bones or tissues.
• True clubfoot: This is the more severe type, where the foot is stiff and cannot be manipulated. There are usually abnormalities of the foot and ankle tendons, making walking impossible.

In most cases, doctors can diagnose clubfoot from birth through a physical examination of the infant. The condition can be clearly observed with the following signs:

• The foot turns inward and downward, with the toes pointing down.
• The heel turns inward.
• The foot is stiff and cannot be positioned normally.
• In some cases, the calf may be smaller than normal.

Clubfoot can be completely cured, but it's important to start treatment as early as possible, especially within the first weeks after birth. At this stage, the bones and tissues of the infant are still highly flexible, allowing them to respond well to treatment and reducing the risk of long-term complications.

The most widely used and successful treatment is the Ponseti method, which consists of the following main steps:

• Casting: The doctor gradually manipulates the infant’s foot into the correct position and applies a plaster cast from the toes to the upper thigh. The cast is changed every week, with this process repeated about 5-7 times, until the foot is nearly in a normal position.
• Tenotomy: When the foot has improved to a good position, the doctor makes a small cut in the Achilles tendon to allow the heel to rest fully on the ground. This is a minor procedure done in a clinic or small operating room, takes little time, and usually does not require general anesthesia.
• Bracing: After the Achilles tendon is cut, the infant must wear a foot abduction brace or Ponseti brace for 23 hours a day during the first 3 months. After that, the brace is worn only during naps and at night until about 4-5 years of age, to prevent recurrence of clubfoot.
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In severe cases of clubfoot, cases that do not respond to the Ponseti method, or recurring cases, corrective surgery may be considered. If tendon correction is required, it can be done from birth up to 1 year of age. If bone correction is needed, it should be performed between 5-10 years of age. However, such surgical cases have become much less common due to the effectiveness of the Ponseti method.

Strict adherence to care is important to make the treatment effective:

• Cast care: Check that the cast has no cracks or moisture. If there are any problems, notify the doctor immediately.
• Watch out for abnormal signs: Observe whether the child's foot develops pain, swelling, redness, or foul odor.
• Bathing: Take care not to let the cast get wet.
• Prescription shoes and a brace: Follow the doctor’s instructions strictly, and do not remove them before the scheduled time.
• Cleaning: Clean the foot and ankle when the brace or cast is removed for changing, or when changing shoes and brace.
   

Clubfoot can recur if not cared for consistently. The most important ways to prevent recurrence are regular follow-ups with the doctor and strictly following instructions for wearing the shoes and brace. This allows monitoring of the foot’s development and adjustment of treatment as needed.

Clubfoot is no longer something to fear, as doctors can detect this condition from birth and provide timely treatment. With medical advances and proper treatment methods, your child can have strong feet and live a happy life to their full potential.

Samitivej International Children’s Hospital has the capability to care for children at all levels, from newborns to pediatric patients requiring treatment with advanced technology, by a team of pediatricians, nurses, and specialists.

The pediatric surgery team has the capacity to perform surgery on 1,000 pediatric patients per year, from birth, using minimally invasive surgery. Newborn and pediatric minimally invasive surgery utilizes small instruments, with incisions as small as 2mm, reducing injury and allowing faster recovery.

The hospital is also equipped with a hybrid operating room that uses bi-plane technology on the X-ray machine that produces images in multiple planes, supporting immediate emergency diagnosis and surgical decision-making. This increases the hospital’s surgical capacity and capability to care for patients requiring complex surgery.