Club foot is a deformed ankle and foot and is present at birth. The ankle is twisted and the foot points down and inwards
Introduction
Causes of talipes
Diagnosing talipes
Treating talipes
Introduction
With this condition the ankle is twisted, the foot points down and inwards and the soles of the feet face each other.
This happens because the tendons on the inside of the leg have shortened, the bones are abnormally shaped and the Achilles tendon (at the back of the heel) has tightened.
In 50% of cases of club foot, both the feet are affected (bilateral).
Some people refer to club foot as talipes; in fact, there are two types of talipes:
- congenital talipes equinovarus (club foot), and
- talipes calcaneovalgus, where the foot points upwards and outwards.
These pages focus on club foot.
How common is it?
Club foot affects one in every 1,000 babies and occurs more often in boys than girls. It is one of the most common abnormalities at birth.
If you have had a child with club foot, there is approximately a one in 30 chance that your second child will also be affected.
What is the cause?
In most cases, the cause of club foot is unknown. Occasionally it runs in the family.
Can it be treated?
Some mild cases of the condition may not need treating at all. More severe cases will need corrective treatment, ideally soon after the child has been born.
Club foot is usually treated using a technique called the Ponseti method, where the baby’s foot is manipulated into position and put in a cast. Boots with a bar have to be worn. See the Treatment section, above, for more information.
How serious is it?
Club foot is not painful and early treatment is usually effective in correcting the abnormal position of the feet. It is important to review the condition regularly as the child may have a relapse and need more treatment.
Causes of talipes
Usually, the cause of club foot is unknown.
Occasionally club foot runs in the family. If one parent has club foot, there is a 3–4% chance that their child will have the same condition.
If both parents are affected, there is a 15% chance that their child will have club foot.
Diagnosing talipes
Club foot can be detected in an unborn baby by ultrasound but it cannot be treated before birth. If club foot is detected in the womb, you may have more tests to see if your baby has any other problems, such as restricted growth.
Club foot is often discovered at birth as all newborn babies are routinely checked and the condition is usually immediately visible.
If club foot is diagnosed, your GP will examine your baby to check for other conditions that are sometimes associated with club foot, such as spina bifida and muscular dystrophy.
Treating talipes
Your child’s club foot will usually be treated in the weeks following birth. Treatment aims to give your child pain-free and functional feet.
The main treatment for club foot is a technique called the Ponseti method. A growing number of orthopaedic specialists (bone specialists) are now using this treatment and it is available in many clinics, although not all hospitals provide the service.
The Ponseti method
The Ponseti method involves weekly sessions in which a specialist manipulates your baby’s foot with their hands, gradually correcting the bend in the foot. They then apply a plaster cast from your baby’s toes to their thigh to hold the foot in its new position.
The cast is changed at each session and your baby’s foot is corrected a little more each time. In total, four to 10 casts are usually used.
Manipulation and casting of the foot are done very gently so should not hurt your baby.
After this, the specialist decides whether your baby’s Achilles tendon needs to be released (see the box, right). This is a very minor operation that most babies will need.
When the foot is fully corrected, your child has to wear special boots attached to a bar (brace) to hold their feet in the most effective position.
The boots are worn 23 hours a day for two or three months and then just at night and nap times for up to four years.
It is extremely important that your child wears these boots for the necessary time, otherwise the foot may return to the way it was and treatment may have to be started all over again.
For more information on the Ponseti method, including the types of boots available and how wearing these may affect your child, read the leaflet provided by the charity Steps
Surgery
As part of corrective treatment, many babies will need to have a small operation to release the tight tendon at the back of their heel (the Achilles tendon).
This is normally done at around nine months of age under local anaesthetic. A small cut is made in the heel and the foot is plastered in a half-corrected position and re-plastered in a fully corrected position two weeks later.
Only a small number of children need to have further surgery, at the age of around four to seven years, which involves moving the tendon to a different position to help the foot function better.