Club Foot  – Types, Risk factors, Symptoms, and Treatments

Introduction

Club foot is a foot abnormality which causes the baby’s foot to become twisted, upside down or turned in. Club foot is also called as talipes. These abnormalities are present at birth.

Club foot is a common birth defect. It occurs when the large tendon called the Achilles tendon is too short. Club foot can occur in one leg or both legs.

Club foot will not be painful for babies, but as the child age, the disability can become painful. Club foot can make a child’s movement difficult if left untreated.

Description

Club foot can be seen as a twisted foot. The twisted foot can be inward or downward. The heel will be turned inward with an increased arch.

According to NCBI, Club foot is common in boys, and one in thousand babies are affected by Club foot. In most cases, Club foot can be detected with an ultrasound.  

Types of Club foot

The common classification of Club foot— idiopathic, neurogenic and syndromic.

Idiopathic Club foot

Idiopathic Club foot is also known as talipes equinovarus and is common among the other types of Club foot present at birth. Idiopathic Club foot is seen in one out of a thousand babies—half of the cases have only one deformed foot.

The cause of idiopathic Club foot is not clearly known. However, currently, there is much research to find out the cause. According to NCBI, males are more vulnerable to deformity when compared to females. However, there is a consensus on whether the severity of deformity is attributed to gender.

Neurogenic Club foot

The name neurogenic Club foot is caused due to underlying neurological conditions. If the neurogenic Club foot is left untreated, it can lead to cerebral palsy or spinal cord compression.

Syndromic Club foot

Syndromic Club foot is associated with other underlying clinical conditions. Congenital talipes equinovarus are also called as syndromic Club foot. A syndromic Club foot occurs in many neurological and neuromuscular disorders.

According to NCBI data, the congenital talipes equinovarus is 2–2.5 times more common in males when compared to females, regardless of the population.

Risk Factors

The common risk factors of Club foot are discussed below.

Gender

Males are more susceptible to Club foot when compared to females. However, there are many contradictions in regard to gender. According to NCBI data, both males and females are susceptible to certain types of Club foot.

For example, idiopathic Club foot is twice as common in males than in females. The reason for males getting affected by this deformity is still unknown and not clear.

Heredity

Hereditary plays a major role in Club foot deformity. The risk factor increases with a parental history of Club foot. Club foot can be caused when the first child is born with a Club foot, and this mutation is transferred to the next generation.

Causes of Club foot

The causes of Club foot are not clearly understood. However, the predicted reasons can be genetic and environmental factors.

Genetics

Club foot is an inherited disorder and is estimated to be a birth defect. NCBI data stated that 20% of the deformity is caused due to genetic syndromes like trisomy 18 or chromosome 22q11 deletion syndrome.  

In other cases, the cause of Club foot is unknown. A recent study suggested that early limb development can play an important role in Club foot aetiology.

Apart from genetic factors, Club foot can be caused when there is an abnormality in the bones, like spinabifida, at the time of birth.

Club foot can run in families. According to National Health Services, it stated that when the first child is affected with a Club foot, one in thirty-five children who are born next will have a Club foot.

If one parent is affected by a Club foot, there is about one in thirty chances for the baby to be born with a Club foot.

If both the parents are affected by a Club foot, the chance of the baby getting affected by a Club foot will increase to one in three.

Environmental Factors

Environmental factors can play a major role in Club foot deformity. When a woman smokes during pregnancy, it can increase the chance of their baby getting affected by Club foot.

When there is less amniotic fluid surrounding the baby, it can also cause a Club foot during birth. The risk of Club foot increases with amniotic fluid leakage.

Other environmental factors and genetic factors include the genes responsible for the metabolism of tobacco, elevated maternal homocysteine, seasonal viral infections and methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms.

Symptoms

If a child has Club foot deformity, these will be the common symptoms exhibited.

Feet turning inwards

When the baby is born with feet turning inward, it can indicate that the baby is born with Club foot deformity.

Abnormal shape of the foot

The foot will be in an abnormal shape. The Club foot will be comparatively smaller than the normal foot. In most cases, the deformed foot will be twisted upside down or turned downwards.

Tightness of calf muscles

The affected leg will have a smaller calf muscle which can cause tightness in the muscle. The deformed foot will be smaller than the other foot.

These symptoms can be avoided when the affected child is evaluated by a geneticist and other medical professionals who can treat them.

Diagnosis

In most cases, Club foot can be diagnosed after child birth. When the baby is born, the doctor will have a physical examination to diagnose the appearance of the baby’s foot.

In other cases, x-rays can also help diagnose a Club foot. Club foot can also be diagnosed when the child is in the womb with the help of an ultrasound. Ultrasound can help to diagnose most deformities.  

So, it is recommended by many doctors that pregnant women regularly get their ultrasound and consult their doctor. This will help to monitor the child’s growth and development.

Club foot can be diagnosed during a foetal screening at 12 weeks of gestation. However, the presence of a Club foot can also be diagnosed with a physical examination after the baby has been born.

Some babies may be born with normal feet and will have an abnormal position. This is because the baby might have been squashed in the womb. In these cases, the abnormal positioning will resolve itself in three months’ time.

Treatment

When the baby is diagnosed with Club foot, the treatment starts within 1-2 weeks. Some of the common treatments are listed below.

Massage

Daily stretching and massage can help to correct the deformed foot. This will involve gently massaging the deformed foot of the baby. These massages are performed by physical therapy professionals.

Massage therapy can give improvements after three months of treatment. Also, parents are given certain instructions and training to massage the baby at home. However, massages can be done at home only if the doctor advises the parents to perform them at home.

Ponseti method

The ponseti method is the common treatment for Club foot. This method involves moving the baby’s deformed foot and placing it in a correct position and then placing it in a cast to hold the corrected foot.

There will be repositioning and recasting of the baby’s foot once in a few months. This will help the deformed foot to align in the correct position, and there will be no difficulty in the movement of the baby.

This ponseti method can be repeated every 5-8 months and then followed by minor surgery. The surgery will loosen the Achilles tendon in the deformed foot. This surgery will help to fix the deformed foot.

Surgery

The surgery will be performed to loosen the tight Achilles tendon. There will be a small incision made at the back of the tendon, and then it will be gently stretched and the tendon will be slit.

After that, the tendon will be moved and placed in the correct position. The incision will be closed with one or two stitches. This procedure is called tendon lengthening. This surgery will help the child’s foot to stretch and grow in the correct position.

The child can be taken after the surgery. The child can experience some discomfort, and later it will resolve on its own.

Physiotherapy

Physiotherapy will help the child’s foot to become flexible. This will be done by a professional physiotherapist.

Conclusion

Club foot is a congenital deformity which causes the baby’s foot to appear clubbed. With proper medical assistance, the deformed foot can be corrected within five years.

If the Club foot is left untreated, it can cause movement difficulty in later stages of the child’s life. It can also be painful.

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