Clubfoot

Talipes equinovarus; Talipes

clubfoot

Clubfoot is when the foot turns inward and downward. It is a congenital condition, which means it is present at birth.

Causes, incidence, and risk factors

Clubfoot is the most common congenital disorder of the legs. It can range from mild and flexible to severe and rigid.

The cause is not known, but the condition may be passed down through families in some cases. Risk factors include a family history of the disorder and being male. The condition occurs in about 1 out of every 1,000 live births.

Symptoms

The physical appearance of the foot may vary. One or both feet may be affected.

The foot turns inward and downward at birth, and is difficult to place in the correct position. The calf muscle and foot may be slightly smaller than normal.

Signs and tests

The disorder is identified during a physical examination. A foot x-ray may be done.

Treatment

Treatment may involve moving the foot into the correct position and using a cast to keep it there. This is often done by an orthopedic specialist. Treatment should be started as early as possible — ideally, shortly after birth — when it is easiest to reshape the foot.

Gentle stretching and recasting will be done every week to improve the position of the foot. Generally, five to 10 casts are needed. The final cast will stay in place for 3 weeks. After the foot is in the correct position, the child will wear a special brace nearly full time for 3 months. Then, the child will wear the brace at night and during naps for up to 3 years.

Often, the problem is a tightened Achilles tendon, and a simple procedure is needed to release it.

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Some severe cases of clubfoot will need surgery if other treatments do not work, or if the problem returns. The child should be monitored by a health care provider until the foot is fully grown.

Expectations (prognosis)

The outcome is usually good with treatment.

Complications

Some defects may not be completely fixed. However, treatment can improve the appearance and function of the foot. Treatment may be less successful if the clubfoot is linked to other birth disorders.

Calling your health care provider

If your child is being treated for clubfoot, call your health care provider if:

  • The toes swell, bleed, or change color under the cast

  • The cast appears to be causing significant pain

  • The toes disappear into the cast

  • The cast slides off

  • The foot begins to turn in again after treatment

In India it is estimated that over 50,000 children are born with clubfoot every year making it an important factor of disability amongst our children. Delivering inaugural address at the “National Clubfoot Conference” organized to raise awareness on the prevalence of Clubfoot deformity here today, he has said that while clubfoot is easily identifiable and curable based on timely intervention; as a large number of children suffering from the disease are from the rural areas, they remain permanently disabled for want of access to timely cure and treatment.

He expressed his concern that it is estimated that in India there are more than 10 million persons with locomotor disabilities. Until two years ago, Polio was a major cause of disability. However, thanks to an effective anti-polio program, based on Government, NGO and international partnership, we have not had a single case of paralytic poliomyelitis for the last two years. With the eradication of Polio, it becomes logical to address the other causes of childhood disabilities; congenital clubfoot is one of them.

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Until recently many children with clubfoot were treated surgically, which is not only an expensive but a less than fully satisfactory option due to relatively poor long-term results. Apparently, now a new method –The Ponseti Method– can correct the foot deformity in children in a more cost effective and efficient manner. Its relevance in low resource setting cannot be over estimated. The Ponseti method is now the standard of all National Clubfoot programs across the globe. It’s phenomenal success is attributable to a combination of sound scientific knowledge, applied in an integrated socio-medical environment using the already existing health care delivery system in many countries.

National Clubfoot Conference

The Conference is expected to provide the doctors and experts from India and abroad an interactive platform to share experiences and update themselves on newer knowledge and techniques in the treatment of clubfoot disease.

It is estimated that in India there are more than 10 million persons with locomotor disabilities. Until two years ago, Polio was a major cause of disability. However, thanks to an effective anti-polio program, based on Government, NGO and international partnership, we have not had a single case of paralytic poliomyelitis for the last two years. With the eradication of Polio, it becomes logical to address the other causes of childhood disabilities; congenital clubfoot is one of them.

In India it is estimated that over 50,000 children are born with clubfoot every year making it an important factor of disability amongst our children. While clubfoot is easily identifiable and curable based on timely intervention; as a large number of children suffering from the disease are from the rural areas, they remain permanently disabled for want of access to timely cure and treatment.

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Until recently many children with clubfoot were treated surgically, which is not only an expensive but a less than fully satisfactory option due to relatively poor long-term results. Apparently, now a new method –The Ponseti Method– can correct the foot deformity in children in a more cost effective and efficient manner. Its relevance in low resource setting cannot be over estimated.

The Ponseti method,  is now the standard of all National Clubfoot programs across the globe. It’s phenomenal success is attributable to a combination of sound scientific knowledge, applied in an integrated socio-medical environment using the already existing health care delivery system in many countries.

This programme has been launched under the public- private partnership mode with several State Governments partnering CURE International India to make this option a reality for the needy patients. It is particularly heartening to know that a large number of poor and deprived patients are able to access this method of treatment. In a short span of 3 years the program has become the largest in the world with over 7000 children enrolled for free treatment in 18 states in India and more are being added.

One of the key components of clubfoot care is follow up, as this condition can recur as the child grows older. It is good that the clubfoot program in partnership with Government medical colleges and CURE International India is documenting all cases and closely following up all the children treated with clubfoot.

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Raja Raja Cholan
About Raja Raja Cholan 615 Articles

Trainer & Mentor for aspirants preparing for civil service examination

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