How is clubfoot diagnosed?
Ultrasound done while a baby is in the womb can sometimes detect clubfoot. It is more common for your doctor to diagnose the condition after the infant is born, though, based on the appearance and mobility of the feet and legs. In some cases, especially if the clubfoot is due just to the position of the growing baby (postural clubfoot), the foot is flexible and can be moved into a normal or nearly normal position after the baby is born. In other cases, the foot is more rigid or stiff, and the muscles at the back of the calf are very tight.
X-rays may not be helpful to confirm the diagnosis. Some of the baby's foot and ankle bones are not fully ossified (filled in with bony material) and do not show well on X-ray.
How is clubfoot treated?
When treatment for clubfoot starts soon after birth, the foot grows to be stable and positioned to bear weight for standing and moving comfortably.
Nonsurgical treatments such as casting or splinting are usually tried first. The foot (or feet) is moved (manipulated) into the most normal position possible and held (immobilized) in that position until the next treatment. In Canada and the United States this is usually done with a cast, but in some countries strapping with adhesive tape or splinting is more common. This manipulation and immobilization procedure is repeated every 1 to 2 weeks for 2 to 4 months, moving the foot a little closer toward a normal position each time. Some children have enough improvement that the only further treatment is to keep the foot in the corrected position by splinting it as it grows.
The two common methods of manipulation and casting are the "traditional" and the Ponseti (Iowa) methods. In traditional treatment, one position of the foot at a time is treated with manipulation and casting. Usually, the inward direction of the front of the foot is corrected first. If the foot is not responsive, major surgery is performed to further straighten the foot.
In the Ponseti method, two problems with foot position (the front part of the foot being turned in and up) are corrected at the same time. Toward the end of the series of castings, if the whole foot is pointing down, children treated with this method still need a minor surgery to lengthen the tight Achilles tendon. This is usually an outpatient procedure. The Ponseti method works well if it is started right away and if the doctor's instructions for bracing are followed after casting is finished. It helps at least 90 out of 100 children who have clubfoot.1