Club Foot

What is club foot?

Club foot is an abnormality which affects the ankle and foot; some people also refer to this condition as talipes. If somebody has a club foot, their ankle will be twisted and their foot will point inwards and downwards; consequently, the soles of the feet point towards each other. A club foot occurs as a result of the tendons in the leg being shortened and the Achilles tendon being tighter than usual; the bones that form the ankle joint are also shaped differently.

Club foot affects around 1 in 1000 babies and boys are more commonly affected than girls. Around 50 percent of people with club foot are affected on both feet; this is known as bilateral club foot.

Some people refer to club foot as talipes; there are two different forms of talipes, including:

• Congenital talipes equinovarus (club foot)
• Talipes calcaneovalgus (this is when the foot points upwards and outwards, rather than downwards and inwards)

What causes club foot?

In the vast majority of cases, the cause of club foot is unknown. Sometimes, club foot runs in the family and there is a 1 in 30 chance that you will have a baby with club foot if you have already had a child with the condition.

If one parent has a club foot, there is 3-4 percent chance that the baby will have club foot. If both parents have club foot, there is 15 percent chance that the baby will have the condition.

How is club foot diagnosed?

Most cases of club foot can be detected using an ultrasound scan; however the condition cannot be treated during pregnancy. If club foot is detected during pregnancy, your doctor may suggest further tests to see if the baby has been affected by any other conditions; often this will involve amniocentesis testing, which can detect a range of inherited conditions and birth defects.

If the condition is not diagnosed during pregnancy, it will be diagnosed during the examination which takes place immediately after birth. The doctor will also examine the baby to check for symptoms of other conditions and they may suggest further tests.

How is club foot treated?

Most babies with club foot receive treatment within the first few weeks of their lives. Treatment usually involves a technique called the Ponseti method. The Ponseti method of treatment involves sessions on a weekly basis; the sessions are carried out by orthopaedic specialists who manipulate the baby’s foot and ankle. The manipulation exercises are designed to correct the positioning of the foot; once this process is complete the baby’s leg is put in a cast to hold the foot in place. Usually children will wear up to ten casts, as the cast is replaced with a new cast after each session. Once the foot is in the correct place and the Achilles tendon has been released (this is a very minor operation, which is conducted under local anaesthetic; it is usually carried out when the child is around nine months old), the child will be required to wear special boots which are fitted to braces. These boots are very important because they help to hold the feet in the correct position; boots should be worn for 23 hours a day for the first few months and then just at night and during sleeps in the daytime up to the age of four.

It is really important that the child wears the boots and braces for the required period of time, as this will ensure their foot stays in the correct position.

In the majority of cases, no further surgical treatment should be needed after the Achilles tendon has been released; however, in rare cases another operation may be required to move the tendon slightly; this is usually carried out between the ages of 4 and 7.

How serious is club foot?

In many cases, club foot is a mild condition, which can be treated effectively. Although the foot looks awkward and painful, club foot is not a painful condition and the child should not experience serious discomfort. It is understandable for the initial reaction of parents to be alarmed and concerned about their baby having the condition; however, treatments have been proven to be highly effective and many children go on to live perfectly happy and normal lives.

Support for parents

If you want to find out more about club foot or you need help or advice, you can talk to your GP or midwife or contact the charity Steps.