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
If a few months of progressive manipulation and
immobilization don't move the foot into a more normal position, your child's
doctor may suggest surgery. The most common surgical procedures are to lengthen
or release the tight soft-tissue structures, including
tendons such as the heel cord (Achilles tendon), and
to reposition the bones of the ankle as needed. Small wires are often used to
hold the bones in place and then are removed after 4 to 6 weeks. Splinting or
casting is usually used after surgery to keep the foot in the correct position
After either nonsurgical or surgical treatment,
your child usually wears splints for a period of time to keep the clubfoot from
starting to form again. Your child should also have regular check-ups until he
or she stops growing. If your child had surgery, he or she may also need
A mild recurrence of
clubfoot is common, even after successful treatment. Also, the affected foot
will continue to be somewhat smaller (often 1½ shoe sizes or less) and stiffer
than the unaffected foot, and the calf of the leg will be smaller. But after
treatment most children are able to wear shoes comfortably and to walk, run,
and play. If your child is not walking by the time he or she is 18 months old,
you may need to see a specialist to make sure that your child doesn't have
another health problem.