Clubfoot or talipes is a congenital deformity of the foot that occurs in approximately 1:1000 births with half of them being bi-lateral (both feet) and it is twice as common in boys as in girls. The foot has a typical appearance of pointing downwards and twisted inwards. Since the condition starts in the first trimester of pregnancy, the deformity is quite established at birth, and is often very rigid.
There are three main types of defects:
- Equinovarus – This is the most severe type. The foot is twisted inward and downward so that the child cannot place the sole flat on the ground but must walk on the ball, the side, or even the top of the foot.
- Calcaneus valgus – In this moderately severe form, the foot is angled upward and outward so that the child has to walk on the heel or the inner side of the foot.
- Metatarsus varus or adductus – The mildest form of defect does not involve the ankle but only the bones and connective tissues of the foot, causing the front part to turn inward.
No one really knows what causes the deformity. There may be a positive family history. A postural clubfoot is caused by position of the fetus in utero and is usually mild responding quickly to serial casting. Sometimes a child born with clubfoot will also have other congenital deformities such as in Evan’s case, amniotic band syndrome. In some instances a child born with myelomeningocele (spina bifida) or arthrogryposis may also have clubfeet. Beyond these observations, no actual cause is known. If your child has clubfoot, it is not due to anything you did or did not do during pregnancy.
During development, the posterior and medial tendons and ligaments (in the back and inside) of the foot fail to keep pace with the development of the rest of the foot. As a result, these tendons and ligaments tether the posterior and medial parts of the foot down, causing the foot to point downwards and twist inwards. The bones of the feet are therefore held in that abnormal position. Over time, if uncorrected, the bones will become misshapen.
Clubfoot does not cause pain in the infant. Because it is so obvious, it is usually discovered at birth. If left untreated, the deformity does not go away. It gets worse over time, with secondary bony changes developing over years. An uncorrected clubfoot in the older child or adult is very unsightly, and worse, very crippling. The patient walks on the outside of his foot which is not meant for weight-bearing. The skin breaks down, and develops chronic ulceration and infection.