OVERVIEW

What is clubfoot?

Clubfoot typically corresponds to the medical diagnosis of talipes equinovarus, which is divided into congenital clubfoot and acquired clubfoot.

• The former can often be detected by prenatal ultrasound during the fetal stage and is usually associated with genetic factors or external teratogenic factors (such as passive or active smoking during pregnancy). Some cases may be accompanied by malformations of other organ systems. It can be clinically diagnosed after birth, and relevant differential diagnoses should be performed to avoid missed diagnoses.
• The latter is commonly seen after lower leg trauma, fractures, or iatrogenic factors (such as damage to the common peroneal nerve caused by lower limb interventional procedures). It often presents with abnormal foot appearance (the forefoot turns inward, the heel tilts inward, and there is a depression in the midfoot; in severe cases, deep skin folds may appear in the midfoot and heel areas). The ankle joint cannot flex upward, and the heel cannot touch the ground when walking, causing the outer edge of the foot to bear weight. Prolonged walking may lead to calluses on the outer foot.

Early treatment for clubfoot yields better outcomes. The long-term cure rate for congenital clubfoot treated with the Ponseti casting method reaches 95%.
Untreated or delayed treatment of clubfoot can result in an inability to walk normally, loss of self-care ability, potential low self-esteem, difficulty integrating into society, and impacts on social interactions and daily life.

Is clubfoot common?

Congenital clubfoot, as a musculoskeletal birth defect, ranks high in incidence. It can be detected via ultrasound during the fetal stage, with an average incidence of 1 in 1,000 births, occurring more frequently in boys than girls.

What are the types of clubfoot?

Clubfoot is divided into congenital and acquired types.
Congenital clubfoot refers to a foot deformity present at birth, which may include positional clubfoot due to intrauterine compression, idiopathic clubfoot of unknown cause, or clubfoot resulting from spinal or neurological disorders. Some cases are associated with malformations of other organ systems (such as heart, genital, or limb deformities) and may present as part of a syndrome, commonly seen in trisomy 21 or trisomy 18.
Acquired clubfoot often occurs after lower leg fractures or interventional procedures for vascular tumors that damage the common peroneal nerve. These patients typically have normal feet before the condition develops.

SYMPTOMS

What are the common manifestations of clubfoot?

True clubfoot often presents with abnormal foot appearance (the forefoot turns inward, the heel tilts inward, and there is a depression in the midfoot; in severe cases, deep skin folds may appear in the midfoot and heel areas). The ankle joint cannot dorsiflex, leading to abnormal gait while walking, with the heel unable to touch the ground and the outer edge of the foot bearing weight. Prolonged walking may cause calluses on the outer skin of the foot and foot pain. For positional clubfoot, patients typically experience gradual normalization of foot appearance over time.

What are the risks of clubfoot?

True clubfoot is a disabling foot condition. Due to foot deformity, patients often cannot walk or run normally, affecting their daily work and life, and are prone to psychological issues. Untreated or delayed treatment of clubfoot leads to prolonged weight-bearing on the outer edge of the foot, eventually resulting in foot osteoarthritis, causing foot pain and secondary deformities in the spinal joints.

CAUSES

What causes clubfoot?

Compression of the fetus in the uterus, damage to the spinal nervous system, and chromosomal abnormalities can all lead to clubfoot. Some cases of clubfoot have unknown causes, known as idiopathic talipes equinovarus. Trauma or fractures to the lower leg, or common peroneal nerve damage following lower limb interventional surgery, can also result in talipes equinovarus.

How does congenital clubfoot occur?

Compression of the fetus in the uterus, damage to the spinal nervous system, and chromosomal abnormalities can all lead to clubfoot. Some cases of clubfoot have unknown causes, known as idiopathic talipes equinovarus.

How does acquired clubfoot develop?

Trauma or fractures to the lower leg, or damage to the common peroneal nerve and lower limb muscles following interventional surgery, can also lead to acquired talipes equinovarus. These patients had normal feet before the condition developed.

DIAGNOSIS

How to diagnose clubfoot?

Patients with true clubfoot exhibit an inverted foot posture in a natural standing position. During clinical foot examination, the deformity cannot be passively corrected, presenting as inward deviation of the forefoot, inward tilting of the heel, and concavity in the midfoot. In severe cases, deep skin folds may appear in the midfoot and heel areas, with limited dorsiflexion at the ankle joint.

What tests are needed for clubfoot?

If parents suspect their child has clubfoot, they should immediately consult a pediatric orthopedic specialist for a clinical foot examination. For confirmed talipes equinovarus, determining the cause and assessing severity is essential, along with evaluating other organ systems for potential associated malformations.

TREATMENT

Which department should I see for clubfoot?

If parents notice their child has clubfoot, it is recommended to seek a professional pediatric orthopedic doctor at a children's hospital or visit a foot and ankle surgeon or hand-foot surgeon at a general hospital for further consultation.
In short, it is best to choose a doctor who has received training in the Ponseti method for clubfoot treatment, especially one with extensive clinical experience.

Does clubfoot require treatment?

Positional clubfoot in children often improves on its own within a short period (e.g., one month) through observation.
However, true congenital talipes equinovarus requires early standardized Ponseti casting treatment. Without treatment or delayed treatment, the child may experience abnormal foot function, difficulty walking, abnormal gait, inability to run or jump normally, and increased treatment difficulty, time, and risks for both doctors and patients.

How is clubfoot treated?

Patients with idiopathic clubfoot require early Ponseti casting treatment, which mainly includes an average of 4–5 cast changes (changed weekly), percutaneous Achilles tenotomy, and wearing a foot abduction brace.
Home rehabilitation exercises serve as supplementary treatment, with regular outpatient follow-ups until the age of 5.

When does clubfoot require surgery?

For true congenital talipes equinovarus, Ponseti casting treatment should begin within the first week after birth, during which percutaneous Achilles tenotomy (for young children) is performed to improve ankle equinus deformity.
For older children with rigid congenital clubfoot, Llizarov external fixation surgery is required.

How much does clubfoot surgery cost?

The specific cost depends on the local hospital’s pricing standards (hospital level, insurance policies, etc.), the surgical materials chosen (imported or domestic), and the severity of the condition.
Generally, Ponseti casting, the gold standard for congenital clubfoot treatment, is low-cost, with surgery fees under 10,000 RMB. Llizarov external fixation surgery costs around 30,000 RMB.

Does clubfoot surgery require anesthesia? How long does the surgery take?

For cooperative patients, the percutaneous Achilles tenotomy in the Ponseti method can be performed under local anesthesia, and an experienced surgeon can complete it in about half an hour.
For uncooperative young children, general anesthesia is required, and the surgery takes 2–3 hours, depending on the severity of the condition, surgical difficulty, and the surgeon’s skill level.

Does clubfoot surgery require hospitalization? How long is the hospital stay?

The percutaneous Achilles tenotomy under local anesthesia (suitable for young children with clubfoot) typically requires 1–2 days of hospitalization to ensure the child’s safety and prevent complications.

How long does it take to recover after clubfoot surgery?

For percutaneous Achilles tenotomy under local anesthesia (suitable for young children), healing takes about 3 weeks, after which the foot abduction brace can be worn.

Is follow-up required after clubfoot surgery?

Regular follow-ups are necessary after surgery, especially before the wound heals. Keep the wound clean and dry, and monitor blood circulation and movement in the lower limbs.
After removing the cast or external fixator, short-term clinical follow-ups with the surgeon are recommended to prevent early recurrence.

Can clubfoot be completely corrected?

Early and standardized treatment can fully correct foot deformity, with good long-term foot function.
The Ponseti method, the gold standard for idiopathic clubfoot treatment, originated in the 1940s. After over half a century of clinical practice and extensive case studies, its cure rate reaches 95%.
Famous American figure skater and world champion Kristi Yamaguchi, for example, had clubfoot as a child and recovered fully after standardized treatment.

How long does it take to cure clubfoot?

Ponseti casting treatment for idiopathic clubfoot typically takes about 2 months (mainly involving multiple outpatient cast changes), followed by home rehabilitation until age 5. Depending on the condition, follow-ups are generally recommended until adulthood.

Will clubfoot leave any sequelae?

With Ponseti casting treatment, patients can achieve functionally and cosmetically normal feet in the long term, with no sequelae.
However, incorrect or non-standard casting treatment may lead to secondary deformities, such as rocker-bottom foot.

DIET & LIFESTYLE

What precautions should patients with clubfoot take in daily life?

For children with clubfoot after treatment, it is recommended to follow the doctor's instructions for regular check-ups. Daily physical exercise is important, with activities that help strengthen the muscles and ligaments of the lower limbs and feet, such as cycling, hiking, dancing, and skating.

Do clubfoot patients need follow-up examinations?

For idiopathic clubfoot treated early with the Ponseti casting method, after hospital treatment, it is essential to focus on wearing abduction braces, home rehabilitation, and regular follow-up visits. Rechecks are typically scheduled every 3 to 6 months until the age of 5. After 5 years old, follow-ups can be reduced to once a year based on the child's foot condition, continuing into adulthood.

What should be noted in the care of clubfoot patients?

For idiopathic clubfoot undergoing Ponseti casting, due to the long-leg corrective cast, it is important to monitor blood circulation and movement in the lower limbs to prevent compartment syndrome. During home rehabilitation, observe foot development and appearance closely, and seek medical attention promptly if abnormalities are detected to identify and address recurrence early. When wearing abduction braces, protect the skin to avoid pressure sores. For children who undergo surgical treatment, keep the wound clean and dry to prevent infection.

PREVENTION

How to Prevent Clubfoot?

For patients with a family history of clubfoot, prenatal counseling and early perinatal examinations are recommended to ensure healthy births and avoid exposure to teratogenic factors.
For congenital clubfoot patients after birth, early clinical diagnosis, classification, severity assessment, and standardized treatment are necessary, which yield significant long-term outcomes. For acquired clubfoot, precautions should be taken to avoid lower limb neuromuscular injuries, such as protecting nerves and blood vessels during and after surgery for lower leg fractures or interventional treatment of vascular tumors.

How Can Clubfoot Patients Prevent Other Diseases?

Satisfactory treatment outcomes for clubfoot depend on early standardized treatment and the clinical diagnosis, differential diagnosis, and assessment by experienced physicians.
Additionally, the cooperation and trust of the patient's family are crucial factors in determining treatment success. Family members should maintain communication with the physician, report abnormalities promptly, and return for follow-up consultations when necessary.

What Tests Should Be Done for Congenital Clubfoot When Preparing for or During Pregnancy?

Following the principle of healthy births, teratogenic factors during pregnancy preparation and early pregnancy should be eliminated, such as avoiding exposure to chemicals and polluted environments (water, food, air, etc.), as well as active or passive smoking, while maintaining healthy lifestyle habits.
For advanced maternal age, early prenatal diagnostic assessments are recommended.
Regular prenatal checkups are advised during pregnancy. For fetal clubfoot detected early via ultrasound, multidisciplinary consultations should be arranged, along with prenatal ultrasound and chromosomal testing, and MRI if necessary. Seeking medical assistance from experienced pediatric orthopedic specialists is particularly important.