Sickle Foot: Causes, Symptoms & Treatment

The so-called sickle foot or pes adductus is found mainly in infants. In most cases, this foot malposition regresses on its own or can be corrected therapeutically.

What is sickle foot?

Sickle foot is also known as pes adductus and is a foot deformity that is considered the most common foot deformity among infants. Sickle foot is manifested by an affected person’s forefoot having an inward twist. This inward curvature usually affects both the midfoot and the toes. Depending on the cause of a sickle foot, the big toe can also deviate inward. This is called hallux varus. The heel position is often not affected in a sickle foot. In many cases, a sickle foot affects both feet. As a rule, a sickle foot is not accompanied by pain or restrictions in the mobility of an affected person. Sick foot generally affects boys more often than girls.

Causes

The cause of a sickle foot initially lies in an increased activity of the muscles of the so-called big toe adductor (a muscle that is responsible, among other things, for attaching the big toe to the foot) or the shin muscle. Sickle foot can be congenital or acquired (developed after birth). More common is acquired sickle foot, which is usually less severe than congenital sickle foot. Acquired sickle foot often hides the fact that an affected infant is often in a prone position, which means that the toes often rest on the support. Finally, an already congenital sickle foot can be hereditary or acquired. Sickle foot is hereditary if both parents of an affected infant have corresponding hereditary characteristics. Acquired congenital sickle foot is probably often due to the relative narrowness of the uterus.

Symptoms, complaints, and signs

Sickle foot can normally be detected from the outside. The deformity is manifested by the toe and midfoot being turned inward and the toes being partially or completely displaced inward. The heel is typically bent inward or directed forward. The deformities do not normally affect the mobility of the affected foot. Pain is also rare and occurs only as a result of any deformities. The congenital form also shows an inwardly directed gait. Sickle foot can occur on one or both sides. It usually occurs on both sides, although the severity of symptoms may vary between feet. Congenital sickle foot is often accompanied by other deformities. Affected infants then have, for example, deformed big toes or a flattened metatarsus. This can lead to deformities and, as a result, to joint wear and tear, which is associated with pain and further movement restrictions. Sickle foot can therefore be recognized primarily by its external characteristics. The congenital form persists throughout life, with usually no deterioration in health. Early treatment can effectively resolve the symptoms.

Diagnosis and progression

Sickle foot is usually diagnosed based on the visible, typical deformity of the foot or feet. If a hallux varus has been developed, this usually suggests congenital sickle foot. The diagnosis of a sickle foot is also supported by the fact that the foot is straightened when stroking over the outer edge of the foot. If the degree of development of a sickle foot is to be determined, an X-ray examination is suitable. In the vast majority of patients, sickle foot regresses on its own in the course of physical development. In the remaining cases, the prognosis for treatment is usually good. In a few untreated cases, a sickle foot can lead to pain, osteoarthritis and restricted movement in the long term.

Complications

Untreated sickle foot can cause complications in rare cases. Because of the permanent malalignment of the foot, there is a risk that the midfoot will stiffen. In addition, the joints of the foot, knee, and hip wear severely, causing permanent damage to the joint cartilage. This is accompanied by bone damage – resulting in osteoarthritis and thus permanent movement restrictions. For many of those affected, the altered gait is also a cosmetic flaw that is perceived as unpleasant.In the long term, malocclusion can cause psychological problems such as inferiority complexes or exacerbate existing conditions. Surgical intervention can cause the typical complications: Bleeding, infection and nerve injury. Particularly at risk are the joint capsules, which can be damaged during surgery. This results in sensory disturbances and, in rare cases, permanent movement restrictions. After the operation, wound healing disorders and inflammations may occur. Occasionally, a malposition reappears, which must be treated again surgically. Prescribed painkillers and anti-inflammatories can cause gastrointestinal discomfort, headache, muscle pain, and pain in the limbs, as well as a number of other side effects and interactions. Allergic reactions to the agents and materials used also cannot be ruled out.

When should you see a doctor?

Sickle foot should always be treated by a doctor. In the worst case, this can lead to significant complications and restrictions in the life of the affected person, which can have a very negative impact on the quality of life. For this reason, sickle foot should be treated at the first signs. Self-healing cannot occur with this disease. A doctor should be consulted if the affected person suffers from a clear malposition of the foot. In this case, the heel is not completely forward, which can lead to severe pain in the feet. As a rule, this pain occurs mainly during walking, although it can also occur in the form of pain at rest. In the event of these complaints, a doctor should be consulted immediately. Likewise strong restrictions in the movement point to a sickle foot and should be likewise controlled by a physician. Especially in children, parents must pay attention to the symptoms of this disease and then consult a doctor. Usually, sickle foot can be diagnosed and treated by an orthopedist.

Treatment and therapy

In many cases, sickle foot does not require medical treatment. However, if a therapeutic measure is necessary, it often consists of manual correction of the sickle foot in the infant; if only the forefoot is affected by sickle foot, for example, repeated pressing of the affected foot to the normal position can correct the sickle foot here. Repeated stroking of the outer edge of the foot can also contribute to normal alignment of the sickle foot. Therapeutic support can also be provided by foam rings placed on the lower legs of an infant affected by sickle foot: With the help of the foam rings, the infant’s feet can be prevented from lying with their outer edge on the support in the prone position. More extensive therapeutic steps may be necessary if, in addition to the forefoot, the midfoot is also affected by sickle foot. In this case, for example, plaster casts are applied to the thighs over a period of approximately one to three weeks, which are eventually replaced by so-called positioning shells to be worn at night. When affected children are then walking and standing, special shoe inserts can be used to correct the sickle foot. In a few cases, surgery may be needed to correct sickle foot.

Prevention

If sickle foot is hereditary, its development usually cannot be prevented. To prevent acquired sickle foot, it may be helpful to avoid internal foot rotation with an infant in the prone position. If the first signs of sickle foot appear, it may be advisable to seek medical advice; if necessary, measures against sickle foot can be taken at an early stage. If newborns are diagnosed with sickle foot, treatment is not always necessary because spontaneous correction often occurs during growth. If non-surgical therapies such as special splints, wraps or orthopedic shoes do not lead to success, the positional deformity can be corrected with surgery. Plaster casts are also applied to return the foot to its central position. In the pre- and postoperative follow-up, dimensionally stable positioning splints serve as a comfortable gypsum substitute. Following surgery or after plaster therapy, intensive follow-up treatment with physiotherapeutic procedures is necessary. Special stretching and strengthening exercises are performed to stabilize the foot position.Even in infants, physiotherapy is useful to prevent worsening of lateral rotation of the front foot.

Aftercare

The physiotherapist treats the deformity of the baby’s foot with stroking massages that strengthen the foot muscles and mobilize the toes. During sickle foot aftercare, parents can continue professionally guided foot stretching exercises independently at home. Regular medical check-ups are necessary, especially for surgically treated deformities, but also to ensure the success of conservative therapy measures. Orthopedic shoe insoles serve to maintain the success of treatment in the long term. Antivarus shoes are also used as a supplementary measure of successful physiotherapeutic aftercare. The main costs for these stabilizing shoes are borne by the health insurance companies, provided that an orthopedic diagnosis has been made. Even a later noticed, slightly pronounced sickle foot should be examined by a doctor in any case.

What you can do yourself

Experience shows that sickle foot regresses on its own as the child grows. A medical diagnosis is nevertheless urgently necessary – if only to document the progress of the individual measures. Parents can support the healing process by massages. It is advisable to first practice the corresponding hand movements under therapeutic supervision. The muscles are gently brought into the ideal position. The stretchability of the foot at the inner edge is decisive for success. For older children, exercises with a soccer ball are worthwhile. Especially kicking with the inner side supports the healing process and gives a lot of pleasure. Sickle foot is a serious anomaly. The condition should therefore never be treated exclusively by laypersons. Otherwise, there is a risk of a lifelong walking disability with the resulting professional and private restrictions. Young adolescents can be supported by massages and exercise sessions. A combination of therapy and self-measures promises the best success. In case of complications, doctors try to correct the deformity with plaster casts and surgery. If this is not completely successful, shoes with insoles often have to be used. Pain and pressure points after longer distances then characterize everyday life.