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
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?
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