Clubfoot lifespan hip bone surgery

Clubfoot, also known as talipes equinovarus, is a congenital (present at birth) foot deformity. It affects the bones, muscles, tendons, and blood vessels and can affect one or both feet. The foot is usually short and broad in appearance and the heel points downward while the front half of the foot (forefoot) turns inward. The heel cord (Achilles tendon) is tight. The heel can appear narrow and the muscles in the calf are smaller compared to a normal lower leg.

Often one gender (either male or female) is affected more often than the other in multifactorial traits. There appears to be a different threshold of expression. This means that one gender is more likely to show the problem than the other gender. For example, clubfoot is twice as common in males as it is in females. Once a child has been born with clubfoot, the chance for it to happen again depends on several factors.

If a parent and child are affected, the chance that it may happen again may be as high as 25%. If a parent does not have club foot, then the risk that it may happen again is based on gender of first born—2% risk with a male child and 5% for a female child. What are the risk factors for clubfoot?

Babies born with clubfoot may also be at increased risk of having an associated hip condition, known as developmental dysplasia of the hip (DDH). DDH is a condition of the hip joint in which the top of the thigh bone (femur) slips in and out of its socket because the socket is too shallow to keep the joint intact. How is clubfoot diagnosed?

Your child’s healthcare provider makes the diagnosis of clubfoot at birth with a physical exam. During the exam, your child’s healthcare provider obtains a complete prenatal and birth history of the child and asks if other family members are known to have clubfoot. If the diagnosis of clubfoot is made in an older infant or child, your child’s healthcare provider will also ask about developmental milestones since clubfoot can be associated with other neuromuscular disorders. Developmental delays may need further medical follow up to evaluate for underlying problems.

Nonsurgical treatment. There are various methods of nonsurgical treatment for infants with clubfoot. These methods include serial manipulation and casting, taping, physical therapy and splinting, and use of a machine that provides continuous passive motion. A nonsurgical treatment should be the first type of treatment for clubfoot, regardless of how severe the deformity is.

According to the American Academy of Orthopaedic Surgeons (AAOS), the Ponseti method, which uses manipulation and casting, is the most often used method in the U.S. to treat clubfoot. Most cases of clubfoot in infants can be corrected within 2 to 3 months using this method. It is recommended that Ponseti method treatment be started as soon as clubfoot has been diagnosed, even as soon as 1 week of age. The AAOS states that infants with clubfoot occasionally have a deformity severe enough that manipulation and casting will not be effective.

Surgery. Surgical treatment for clubfoot may be needed in these situations: when nonsurgical treatment fails to correct the deformity, or when the deformity happens again and does not respond to nonsurgical treatment. The specific surgical procedure and extent of surgery will depend on the type and extent of the deformity. Postoperatively, surgical wires, pins, and/or a cast may be used to maintain the corrected foot position until it has healed. Splints may also be needed for several months up to a few years after surgery.

Long leg casts are applied from the upper thigh to the foot. These casts are commonly used in the treatment of clubfoot. They can also be used with knee dislocations, fractures, or after surgery on the leg or knee area. Cast care instructions

Most infants with clubfoot can be corrected with serial manipulation and casting. Some infants may need surgery to help correct the position of the foot. Additional surgeries may be necessary since the deformity may come back as the child grows and develops.