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CLUBFOOT (Talipes Equinovarus)

-is a general term used to describe a

range of unusual positions of the foot.
This is present at birth and affects the foot
and/or ankle. There is no known cause for
clubfoot, and it is twice as common in
male children as it is in female children.
• Most type of clubfoot are present at
birth which can happen in one foot or
in both feet. In almost half of affected
infants, both feet are involved.
• Although clubfoot is painless in a baby,
treatment should begin immediately.
Clubfoot can cause significantly
problems as the child grows, but with
early treatment most children born with
clubfoot are able to lead a normal life
• The frequency of congenital clubfoot is
approximately 1 per 1,240 live births. In
children there is a subtle imbalance in
muscle forces in the lower leg resulting
in the foot deformity. Often, the foot is
‘kidney- shaped”. About 50% of the time,
both feet are affected with clubfoot
What causes Clubfoot?
• Although there is no known cause of
congenital clubfoot, some doctors
believe the use of drugs or alcohol
during pregnancy or the presence of
other diseases can cause it.
• In some cases, clubfoot is just the
result of the position of the baby while
it is developing in the mother’s womb
What are the
Clubfoot is painless in a baby, but
it can eventually cause
discomfort and become a
noticeable disability. Left
untreated, clubfoot does not
straighten itself out. The foot will
remain twisted out of shaped,
and the affected leg may be
shorter and smaller than the
other. These symptoms become
• Clubfoot present at birth can
indicate further health problems,
since clubfoot is associated with
other conditions such as spina
bifida. For this reason, as soon as
clubfoot is identified, it’s
important that the infant be
screened for other health
conditions. Clubfoot can also be
the result of problems that affect
the nerve, muscle, and bone
How is Clubfoot
Ultrasound done while a fetus is
developing can sometimes detect
clubfoot. It is more common for your
health professional 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 developing baby, the foot is
flexible and can be moved into a
In other cases, the foot is more
rigid or stiff, and the muscles at
the back of the calf are very tight.
X-rays to confirm the diagnose
are usually not helpful, since
some of the foot and ankle bones
in an infant are not fully ossified
( filled in with bony material) and
do not show well on x-ray
How is Clubfoot treated?
Treatment for clubfoot usually begins
soon after birth, so the foot grows to
be stable and positioned to bear
weight for standing and moving

Nonsurgical treatment 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 the U.S 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
2 common methods of
manipulation and casting:
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.
Ponseti method
in this method ,two problems w/ foot
position (the front part of the foot being
turned in and up) are corrected at once.
Toward the end of the series of
castings, if the whole foot is pointing
down, children treated with this method
still require a minor surgery to lengthen
the tight Achilles tendon. This is usually
an outpatient procedure.
Recent research indicates that the Ponseti
method is successful in most children
clubfoot if treatment is started immediately
and if the health professional’s instructions
for bracing are followed after casting is
finished. One study indicated that 94% of
children treated with traditional casting will
require major corrective surgery within the
first year of life, while only35% of children
treated with the Ponseti method will
require this major surgery.
by: jhong antonio
A newborn baby with a
club foot or clubbing of his
left foot.
A photo of a newborn baby with a
A photo of a newborn baby in
the NICU with a bilateral
clubfoot deformity.
A two month old infant in a casts
as treatment for his bilateral clubfoot deformity
A two month old infant with a
clubfoot deformity who is being
treated with casting.

Using the Ponseti method, the

club foot is manipulated or
stretched every 5 to 7 days and
the plaster casts are changed.

This baby is on one of his last treatments for his clubfeet

and will then wear a brace for a few years.

The alternative to serial casting is a specialized physical

therapy treatment program, in which the child undergoes
daily stretching and taping of the club foot by a physical
therapist, and eventually, by the parent at home.
A photo of an infant with
bilateral clubfeet who has just
had several months of casting
treatment using the Ponseti
method. He will still have to
undergo daily bracing for most
of the day for many months, but
his feet look great…!!!!
This is a photo of an
infant in a Denis Browne
bar (foot abduction
brace) bar after
undergoing months of
casting using the Ponseti
method as treatment for
his bilateral clubfeet.
He will have to wear the
bracing bar for 23 hours
a day for about 3 months
and then only at night for
two to four years.