Most Common Type:
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|What Is Clubfoot?
A clubfoot is a common birth defect where the foot is twisted out of shape. It is a congenital birth defect which means it is present at birth. The most common form is the so-called equinovarus deformity which means the heel and foot bends inwards (image). In more severe cases the shinbone or tibia may also be twisted in and the lower leg muscles can be under developed. Clubfoot is twice as frequent in boys as girls. Treatment is usually started soon after birth and the appearance and function of the foot should soon improve. The medical term for clubfoot is talipes or talipes equinovarus.
It is a relatively common defect and occurs in about 1 out of every 1,000 births in Western countries. It can occur in one (unilateral) or both feet (bilateral). The occurrence in both feet is between 30-50 percent.
One theory suggests that many cases are the result of pressure on the baby's feet from the mother’s uterus while it was developing in later pregnancy. Depending on where the fetus' feet were placed when the pressure was exerted this would determine if one or both feet were affected or if they were varus (turned inward) or valgus (turned outwards). It may also be for some reason that the baby's joints do not develop the sort of strength they should and thus are more vulnerable to any pressure.
The signs are usually very clear. Key identifying factors are:
Sometimes the condition is discovered during an anatomy scan, usually by week 20 of pregnancy. After childbirth the condition is straight forward to diagnose with a physical examination. An exam will also be performed to rule out any other spinal or muscular conditions. An X-ray of the foot or feet is also taken to determine the extent of bone abnormalities.
Although clubfoot is painless at birth, it can worsen over time if untreated. Untreated children will develop abnormal walking patterns; gradually their feet become crippled and unsightly to look at.
Which Method Is Better?
A study by Steinman et al compared the French functional and Ponseti methods. The study showed that there were no significant differences between the success rates of the therapies (both were about 95 percent successful). However twice as many parents opt for the Ponseti method. Relapses occurred in 37 percent of Ponseti patients and in one third of those cases further non-surgical intervention was successful. However surgery was necessary for the other two thirds. Relapse cases were slightly less at 29 percent for the French Function method however surgery was required in all cases. An overall outcome from the study reported that the Ponseti method gave 'good' results in 72 percent of cases, 'fair' in 12 percent and 'poor' in 16 percent. The French functional method gave 'good' results in 67 percent of cases, 'fair' in 17 percent and 'poor' in 16 percent.
In about 15 percent of cases more extensive foot surgery will be required. This is known as a Posteromedial Release procedure and it usually leads to a better positioning of the foot long-term. It is usually only performed after a child is at least 9 months old, although some orthopedic surgeons choose to operate at 6 months.
If bone abnormalities persist an osteotomy can be performed when the child is at least 5 years of age. It involves cutting into the bone. An arthrodesis procedure which involves fusing and stabilizing the bones can be performed when the child is 10 or older.
Most children do well if treatment is started early and are able to participate in most athletic activities without any problems. The gold medallist figure skater Kristi Yamaguchi for example was a former clubfoot infant. If treatment is delayed however then neither non-surgical nor surgical intervention will be as successful and the child may end up with a foot deformity for life.
Average Surgery Costs (United States)
|Related Articles on Clubfeet
For more on pregnancy complications, see the following:
• Cleft palate: Signs, causes and treatment.
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