$Unique_ID{BRK03610} $Pretitle{} $Title{Clubfoot} $Subject{Clubfoot Calcaneal Valgus Calcaneovalgus Metatarsus Varus Talipes Calcaneus Talipes Equinus Talipes Equinovarus Talipes Varus Talipes Valgus Valgus Calcaneus} $Volume{} $Log{} Copyright (C) 1986, 1987, 1989 National Organization for Rare Disorders, Inc. 265: Clubfoot ** IMPORTANT ** It is possible the main title of the article (Clubfoot) is not the name you expected. Please check the SYNONYMS listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Calcaneal Valgus Calcaneovalgus Metatarsus Varus Talipes Calcaneus Talipes Equinus Talipes Equinovarus Talipes Varus Talipes Valgus Valgus Calcaneus General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Clubfoot is a word used for several kinds of ankle and foot deformities usually present at birth. The defect can be mild or severe, and it can happen to one foot or to both. Symptoms There are several types of clubfoot. They are as follows: EQUINOVARUS The foot is turned inward and downward . If both feet are affected the toes point toward each other instead of straight ahead. The heel cord often is very tight, making it impossible to bring the foot up to a normal position without a specialist's help. CALCANEAL VALGUS OR VALGUS CALCANEUS This type of clubfoot is more common. The foot is sharply angled at the heel, with the foot pointing up and outward. METATARSUS ADDUCTUS The front part of the foot is turned inward. METATARSUS VARUS The front part of the foot is turned inward and inverted. Although present at birth, this form of abnormality may not be diagnosed until the infant is a month to a few months old. With treatment the foot can look better and become more functional. In general, clubfoot is not painful and doesn't bother the baby until he or she begins to stand and walk. Since the ankle is twisted in place, the foot can't move up and down as it normally would in walking. The child must walk as if he were on a peg leg. If both feet are affected, the child walks on the balls of his feet. If the feet are badly twisted, the child will walk on the sides or even the top part of the feet instead of the soles. The part that comes in contact with the ground may become ulcerated, hard and lumpy, since it is not protected by the thick skin of the sole of the foot. The entire leg is sometimes unable to grow as it should. For more information on Clubfoot, see the article in the Prevalent Health Conditions/Concerns area of NORD Services. Causes The exact cause of Clubfoot isn't clear. In the past it was thought that the fetus' feet were twisted in the mother's womb. This is true only of cases that correct themselves after birth. Many scientists think the defect starts early in pregnancy, before the fetus is large enough to stay in one position very long. Clubfoot probably is caused by a combination of hereditary and other factors that may affect prenatal growth, such as infection, drugs, disease or other factors in the environment. Although most children with clubfoot have no other birth defects, occasionally there are other abnormalities as well. Children with an open spine (spina bifida) sometimes have a form of clubfoot. This is caused by damaged spinal nerves that affect the leg muscles. In other cases, feet which are normal at birth may become twisted as a result of muscle or nerve disease. Affected Population Clubfoot is usually present at birth. Approximately 9,000 babies (about one in 400 live births) are born annually in the United States with this congenital defect. Boys are affected twice as often as girls. Therapies: Standard Treatment of Clubfoot is started soon after birth. The aim is to force the twisted foot gradually and gently into place so that it can move up and down. In the mildest cases parents can be taught how to exercise the baby's foot. More often, plaster casts or surgery followed by exercise are needed. Most often, the doctor turns the foot forward as far as it can go, and puts a plaster cast on to hold it that way. At first, the cast is changed to bring the foot closer to normal through frequent adjustments. After the foot is straightened, it is tilted further upward to stretch the tightened heel cord. It is kept in this over-corrected position for a few weeks. The treatment usually requires three to six months, followed by checkups for many years by an orthopedist. In certain cases, some doctors use adhesive bandaging over a special type of splint instead of hard casts. After the bandages are off (or in some mild forms of clubfoot), the baby sleeps in shoes attached to a metal bar which holds the feet in a corrected position. Sometimes the heel cord is too tight to be stretched by a cast or bandaging, and the patient must undergo surgery to lengthen it. Immediate treatment for clubfoot using casts or strapping (not surgery), works in more than half of the cases. With expert early treatment, most patients grow up to wear regular shoes, can take part in sports, and lead full, active lives. Untreated, a clubfoot stays twisted and grows that way. If the defect is treated too late in childhood surgery may be successful, but the rest of the leg usually doesn't catch up in development. Therapies: Investigational This disease entry is based upon medical information available through March 1987. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Clubfoot, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Child Health & Human Development (NICHHD) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5133 For information on genetics and genetic counseling referrals, please contact: March of Dimes Birth Defects Foundation 1275 Mamaroneck Avenue White Plains, NY 10605 (914) 428-7100 Alliance of Genetic Support Groups 35 Wisconsin Circle, Suite 440 Chevy Chase, MD 20815 (800) 336-GENE (301) 652-5553 References Clubfoot: Public Health Education Information Sheet, Health Education Information Sheet, March of Dimes (1983).