Diagnosing and treating clubfoot

Clubfoot increasingly is diagnosed prenatally, but there’s no replacement for a pediatrician’s exam.

Prenatal ultrasound increasingly is yielding reliable clubfoot diagnoses, giving parents a chance to prepare themselves and understand the condition.

Still, there’s no replacement for a hands-on exam by a pediatrician.

Idiopathic clubfoot is the most common type of clubfoot, with the other two being positional and syndromic.

Clubfoot is an anomaly characterized by the sole rotated inward. Clubfoot is characterized by four different anomalies that can be remembered using the “CAVE” mnemonic.

  • Midfoot Cavus: The sole faces upward.
  • Adduction of the forefoot: Toes point to the inside, and the medial foot margin is concave.
  • Hindfoot Varus: Medial deviation of the longitudinal axis of the calcaneus.
  • Hindfoot Equinus: Extreme plantar flexion.

A physical exam of the foot considers its morphology, skin folds and flexibility of the muscles and tendons. A child with a more malleable and flexible foot has a better prognosis.

Recent studies have found an insignificant association between idiopathic clubfoot and developmental dysplasia of the hips. Nonetheless, ultrasound remains a valuable tool for spotting developmental dysplasia of the hips regardless of other conditions.

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Preparing and helping families understand the diagnosis

Prenatal diagnosis also has given parents a greater opportunity to prepare to care for infants with clubfoot, often in consultation with their pediatrician.

“Pediatricians are uniquely positioned to help families understand clubfoot and reassure them that there is effective treatment available that does not involve breaking or cutting the bones of the foot,” said James E. Moyer, M.D., nonsurgical pediatric orthopedist at Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine. “Athletics won’t be out of the question. Indeed, there are a number of successful professional athletes and entertainers who were born with a clubfoot.”

The current standard of treatment is the Ponseti method to gradually cast and brace the limb. Relapse up to age 10 is a possibility, and pediatricians can be critical to spotting any need for additional treatment as well as keeping the patient on track with orthopedist follow-ups.

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