Clubfoot is a congenital malformation of the foot, consisting of pointed, sickle and hollow feet and bow legs. Clubfoot is clearly visible right at birth and should be treated from the beginning. In most cases, clubfoot can be well compensated by appropriate therapies and children can learn to walk at the right age without delay.
What is clubfoot?
Clubfoot is the term used to describe the joint occurrence of pointed foot, sickle foot and hollow foot. In this case, the foot is turned inward so that the sole of the foot is facing the other foot rather than downward. In addition, the foot is excessively stretched in the ankle joint and strongly arched in the sole of the foot. Clubfoot occurs more often in boys than in girls and can be unilateral or bilateral. Different degrees of severity are possible. In most cases, children with clubfoot also have severe bow legs and atrophied calf muscles on the affected leg.
Causes
The causes of clubfoot formation are not fully understood. In general, clubfoot is congenital. It is believed that its development is genetically determined. The fact that there is a familial accumulation strengthens the suspicion of genetic causes. One theory for the development of clubfoot is that connective tissues and muscles do not develop in the right proportion during pregnancy and the growth of bones is impaired. It is also thought possible that bone growth stops too early, causing the feet to remain in the embryonic position and not develop further. Furthermore, it is believed that if there is a genetic predisposition, clubfoot is more likely to occur if the mother smokes during pregnancy. Other circumstances may also favor the occurrence of clubfoot, such as a lack of amniotic fluid or an unfavorable position of the child in the uterus.
Symptoms, complaints, and signs
The doctor recognizes a clubfoot at first glance. Usually, it is a combination of several malformations that can affect only one or both feet. If the heel bone is raised in combination with a steep position in the upper ankle joint, the physician speaks of a pointed foot. In contrast, if the lower ankle joint is in a pronounced O-position, the rear foot is tilted inward. In this case, the heel points inward. If the toes and metatarsus are turned inward, a sickle foot is present, while in a hollow foot the longitudinal arch of the foot is elevated. In the absence of treatment, affected individuals can only walk on the outer edges of the feet. In very severe cases, where the sole of the foot is elevated, patients walk on the dorsum of the foot. While the symptoms are clear in newborns, the doctor takes further examinations in unborn babies. In this way, he makes sure that it is indeed a clubfoot and that the child has not just adopted a clubfoot posture. In this context, a shortened, relatively thin calf (the so-called clubfoot calf) is a clear indication that a clubfoot is present. Ultrasound examinations also reveal distinct skin folds that are not present in healthy feet.
Diagnosis and progression
The deformity in clubfoot can be clearly seen at birth. Using various tests, the doctor can determine whether a true clubfoot is present or whether it is another deformity. Important criteria include how much the foot is turned inward, how well individual joints move, the relationship between the length of the foot and the length of the calf, the degree to which the calf muscles are atrophied (atrophied), and whether the blood flow and sensitivity (the ability to feel) of the leg and foot deviate from the norm.
Complications
If clubfoot is not treated, the little feet stiffen in the deformity. This causes children to walk on the outside edge of the foot instead of the sole of the foot. Untreated clubfoot affects the whole body and causes further deformities in the hips, spine and shoulders. The clubfoot would completely stiffen over time and cause severe pain. In case of clubfoot, early treatment is advisable. This can minimize later complications or worsening of the deformities and provide professional treatment for the symptoms of clubfoot.Surgical interventions are often necessary to give the clubfoot as much functionality as possible. The earlier treatment of clubfoot begins, the more likely good results can be expected. Complications often occur postoperatively. The clubfoot can leave permanent damage. Scar tissue formation is a common surgical consequence. In addition, postoperative bleeding, bruising, or injury to surrounding nerve cords may occur. As a result, wound healing problems, lack of sensitivity or paralysis may occur in the surgical area. A blood stasis cuff may pinch off nerve cords or vessels. Another complication involves the bones growing together. In clubfeet, the bones may not grow together properly after surgery. This can lead to premature joint wear. The affected joints may stiffen over time. Making orthopedic shoes is inevitable for clubfoot patients. However, this makes clubfoot much more noticeable. Thus, a psychological burden is possible. Especially young people with clubfoot often suffer from lack of recognition, complexes or depression. The development of a Sudeck syndrome is another possible complication. The bone mass can be increasingly reduced in this case. Inflammatory processes around the clubfoot mean severe pain.
When should you see a doctor?
Visual abnormalities of the foot are an indication of a present disorder. In the case of a congenital peculiarity of the shape of the foot, this is already detected at birth by obstetricians or during the first preventive examinations of the infant by the pediatrician. In these cases, the newborn’s parents usually do not need to take action. Further medical examinations and treatment options are automatically initiated by the attending physician. In case of an acquired irregularity of the foot or both feet, a control examination should be initiated on one’s own responsibility. If there are bony deformities, dislocations of the foot or a malposition, a physician should be consulted. If the forward motion occurs by rolling over the outer edge of the foot or the dorsum of the foot, there is cause for concern. To avoid further damage to the skeletal system, a physician should be consulted. If the affected person notices problems with the musculature of the foot, additional examinations are necessary. A curvature of the calf muscles or a shortened Achilles tendon are signs of an irregularity that should be diagnosed and treated. Misalignments of the body, a tilted pelvis or pain in the shoulders as well as the neck also indicate existing irregularities. A visit to the doctor is advisable to stabilize the general well-being and improve the quality of life. If psychological abnormalities occur in patients of clubfoot, seeing a therapist is advised.
Treatment and therapy
A clubfoot can be treated well today. It is especially important to begin treatment immediately after birth and to follow through consistently. The therapy consists of first bringing the foot into the correct position and keeping it there. On the one hand, this is done manually, i.e. a physiotherapist regularly moves the infant’s foot into the normal position. In addition, a plaster splint is applied, which holds the clubfoot in the desired position. When the child is older, night splints and insoles are used. The therapy of clubfoot according to Ponseti is particularly well known. The doctor had developed a concept with which clubfoot is treated by plaster casts and splints within the first four years of life. If the deformity cannot be corrected by splints, the clubfoot can be corrected by certain operations. It is possible to lengthen the Achilles tendon and thus correct an extreme pointed foot. The position and location of the bones can also be surgically altered.
Outlook and prognosis
Clubfoot is a congenital deformity of the foot. Without seeking medical as well as medical care, no improvement in the situation is expected. There is neither a spontaneous healing, nor can a change of the optical conditions be achieved by alternative healing methods. Rather, a stiffening of the toes or foot is to be expected in the further course. Furthermore, additional areas of the skeletal system are affected.In addition to pain, sufferers often complain of problems with the hips, spine and shoulders. This increases the likelihood of secondary diseases and a further decline in quality of life. The prognosis for medical treatment depends on the extent of the deformity and the patient’s cooperation. For mild impairments, training, special footwear, and psychotherapeutic measures are often used. In some cases, medication is administered to relieve pain. In most patients, long-term physiotherapeutic support and the independent performance of special exercises can significantly alleviate the symptoms. In the case of a severe deformity, surgical procedures are used. These are associated with risks, but give the patient the opportunity to achieve lifelong improvement.
Prevention
Because clubfoot is genetic and other causes are not yet known, no preventive measures can be taken. It is important to treat clubfoot immediately after birth and to continue therapy consistently.
Aftercare
Early and consistent therapy results in good healing prospects. As a result, the clubfoot may disappear completely. Since there is no longer any restriction, follow-up care is therefore not necessary. The patient should only avoid maximum loads. However, this restriction is comparatively marginal. On the other hand, permanent aftercare becomes necessary if the correction of the clubfoot is not completely successful. In this case, scheduled examinations aim to enable a normal life despite the restriction. An essential element of treatment is physiotherapy. It is intended to prevent incorrect posture and to sufficiently stretch muscles and tendons. The patient must also integrate appropriate exercise sessions into his or her daily routine. This is the patient’s own responsibility. As aids, the attending physician regularly prescribes orthopedic shoes and insoles. Only their consistent use can prevent new deformities. In the event of acute problems, the patient contacts the attending physician. The doctor can determine clear changes in the feet by X-ray. Follow-up care therefore only concerns patients whose deformity could not be completely corrected. They need permanent aids to cope with everyday life. Physiotherapeutic exercises are to be performed at home under the patient’s own responsibility. In case of complications, a visit to the doctor is unavoidable.
What you can do yourself
Clubfoot is a deformity that is congenital or can develop later in life. Affected individuals can resort to self-help measures that lead to an improvement in the symptoms that occur. An aggravation or even further consequential damage can be avoided if an appropriate shoe orthopedist is consulted at an early stage. Only with suitable footwear can the present malposition be counteracted. However, if individually adapted footwear is not worn, those affected must expect a considerable deterioration. It is also advisable to see a physiotherapist at an early stage, as this can counteract any circulatory problems. Regular massage and exercise can promote and improve circulation. There are no other measures that can be taken by oneself and at the same time lead to a significant improvement. However, regular visits to the doctor are very significant and should therefore be mandatory. Regular examinations and explicit exercises can lead to a significant improvement in an existing clubfoot. In addition, possible complications can be avoided, so that a much more pleasant course of the disease can be expected. Own measures are therefore only possible to a limited extent. However, the aforementioned should by no means be neglected.
