Club foot is a deformity of the foot and ankle that babies can be born with. The position and function of the foot can be greatly improved, if treated early.
The foot of a baby with club foot points down and inwards, with the soles of the feet facing backwards.
Club foot isn’t painful for babies, but it can become painful as they get older and cause difficulties walking if it isn’t treated.
Club foot is relatively common, affecting around one baby in every 1,000 born in the UK. Both feet are affected in around half of the children born with the condition.
The medical name for club foot is congenital talipes equinovarus.
What causes club foot?
In most cases the cause of club foot is unknown, although there may be a genetic link because it can run in families.
If you have one child with club foot, your risk of having a second child with the condition is around one in 35.
If one parent had the condition as a baby, there is around a one in 30 chance of their children having the condition. If both parents previously had the condition, this increases to around a one in three chance.
In a small number of cases, club foot occurs as part of a more serious underlying condition affecting the baby's development, such as spina bifida.
Diagnosing club foot
Club foot is usually diagnosed after a baby is born, although the problem may first be spotted during the routine ultrasound scan carried out between 18 and 21 weeks of pregnancy.
It cannot be treated before birth, but picking up the problem during pregnancy means you can talk to doctors about the condition in detail and find out what to expect after your baby is born.
Further tests may also be carried out while you're pregnant, to check for conditions such as spina bifida.
How club foot is treated
Treatment for club foot should ideally start within a week or two of the baby being born, but it can still be effective if started later in childhood.
A technique known as the Ponseti method is the main treatment for club foot nowadays. This involves your baby's foot being gently manipulated into a better position and then being put in a cast. This is repeated weekly for around five to eight weeks.
After this stage, it's likely that your baby will need a minor procedure (carried out using a local anaesthetic) to make a small cut in their Achilles tendon. This can help to release their foot into a more natural position.
Your baby will need to wear special boots attached to each other with a bar, to prevent club foot returning. These are only worn full-time for the first three months, then overnight until your child is four or five years old.
The vast majority of children treated with the Ponseti method will have pain-free, normal-looking feet that function well. Most children are able to learn to walk by the usual age and can participate in activities such as sports when they're older.
Some children may be left with a slightly shorter leg and smaller foot on one side if only one of their feet was affected. This won't usually cause any significant problems, but it may mean that your child will be slightly less mobile and may get tired quicker than other children.
Before the Ponseti method was widely adopted, club foot was often treated with surgery to alter the position of the foot. This wasn't always effective and lead to long-term pain and stiffness for some adults.
Treating club foot
If your baby has club foot, treatment to improve the position and function of their feet will usually begin within a week or two of their birth.
The Ponseti method
A technique called the Ponseti method is the main treatment for club foot, as it has been shown to be more effective and have better long-term results compared to the operations used in the past.
The Ponseti method involves weekly sessions with a specialist, who will manipulate your baby's foot with their hands to gradually alter the bend in it. They will then apply a plaster cast from your baby's toes to their thigh to hold the foot in its new position.
The casts will be changed weekly at each session, and your baby's foot will be altered a little more each time. On average, five or six casts are used, but your baby may need to have a few more or a few less, depending on how severe their club foot is.
The procedure shouldn’t hurt your baby, as it’s a gentle manipulation. Babies often cry, but it isn’t usually due to pain.
Following the manipulation stage, your specialist will decide whether your baby needs a minor operation to release the Achilles tendon (the tight tendon at the back of their heel).
This is often carried out after the front of the foot has been manipulated, but the ankle is still not in the best position (usually after the fourth or fifth cast).
The operation is usually carried out using a local anaesthetic on an outpatient basis, so your baby will not have to stay in hospital overnight. In some cases, a general anaesthetic may be recommended, so that your baby is asleep during the operation.
The surgeon will make a small cut in the Achilles tendon to release the foot into a more natural position. Your baby’s foot and leg will then be put in a plaster cast for about three weeks.
A small number of children will also need further surgery when they are a few years older. This often involves moving a tendon in front of the ankle to a different position, to improve how the foot functions.
Boots and bar
After treatment, your baby will need to wear special boots attached to each other with a bar.
These will hold their feet pointing slightly outwards, at about shoulder distance apart, which will help to prevent club foot returning.
The boots will need to be worn 23 hours a day (they can be removed for up to an hour each day so you can bath your baby) for three months. Then just at night and nap times, until your child is about four or five years old.
Normal shoes can be worn during the day and your child should start to walk and run at the same time as any other child.
It's very important that your child wears the boots for the required amount of time, otherwise their foot may return to how it was previously, and treatment may have to begin again.
Sometimes, club foot can return. This is known as a "relapse" and it’s estimated to happen in one or two out of every 10 cases – most commonly during the boots and bar stage. Relapses are more likely to occur if treatment isn’t followed exactly.
If club foot comes back, it may be necessary for some of the treatment stages to be repeated – for example, the foot may need to be manipulated again and put in a cast. However, in some cases, surgery may be required.
Caring for your child
The charity STEPS helps families of children with club foot. If you want to talk to someone about your child’s condition, you can call their helpline on 01925 750271.