Bone, Joint and Muscle Conditions

Clubfoot

What is clubfoot?

Clubfoot is when babies are born with 1 foot or both feet pointing down and in. Their toes point toward the opposite leg, and the bottom of their feet face inward. In some cases, it looks like the baby’s foot is upside down.

A clubfoot cannot be straightened simply by moving it around. The joints and tendons on the inside and back of the foot and ankle are shorter than usual, while those on the outside and front are stretched out, holding the baby’s foot in this unusual position.

Clubfoot does not get better on its own. If it is not treated, it can cause discomfort and make your child’s foot function poorly as they grow up. But with treatment, there is an excellent chance that your baby’s foot will look good and function very well.

  • About 1 in every 1,000 babies is born with clubfoot. Clubfoot does not have anything to do with the baby’s position in the womb. It is mostly a problem passed from parents to children (genetic), and it may run in families.

    If you have 1 baby with clubfoot, the chances of having a second child with the condition are about 1 in 40.

    About half of children with the condition have 2 clubfeet. Children with certain neurological and chromosome conditions are more likely to have clubfoot. Most times children who have clubfoot are otherwise completely healthy.

Clubfoot at Seattle Children’s

Clubfoot is treated by the experts in our Foot and Ankle Deformities Program.

For decades, orthopedic surgeons at Seattle Children’s have treated more children with clubfeet than any other center in the Northwest. As techniques to treat the problem have changed, we have been at the forefront in learning, implementing and promoting the latest advances.

  • Dr. Ignacio Ponseti developed the Ponseti treatment method for clubfeet at the University of Iowa nearly 70 years ago. This method corrects most clubfeet without major surgery, a big change from treatment methods that were common at the time of Dr. Ponseti’s initial work.

    Because of the method’s long-term effectiveness, it is the leading treatment for clubfoot around the world.

    Our doctors were among the first outside of Iowa to learn the method directly from Dr. Ponseti. We were the first in the Northwest to offer the Ponseti method for clubfoot treatment. We are listed as approved practitioners.

    In addition, we have been leaders in teaching the technique to other orthopedic surgeons at national and international conferences, as well as through publications.

    To read more about the Ponseti method, visit Global-HELP, a nonprofit medical literature publishing foundation started by the former director of our Department of Orthopedics, Dr. Lynn T. Staheli.

  • To restore or improve your child’s health, function and quality of life, we often use nonsurgical methods (like medicines, physical therapy and braces), recommending surgery only when we believe it will give your child the best results.

    Many of our pediatric orthopedic surgeons have expanded fellowship training in areas such as:

    • Foot and ankle conditions
    • Sports medicine
    • Tumors
    • Upper extremity surgery
    • Limb differences
    • Neuromuscular diseases
    • Skeletal dysplasia
    • Spine problems

    We have the largest group of board-certified pediatric radiologists in the Northwest. Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image. We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.

Symptoms of Clubfoot

Clubfoot looks like no other condition. At birth, the baby’s foot or feet are turned down and in. They can’t be straightened just by trying to move the foot.

Diagnosing Clubfoot

Doctors can see clubfoot on ultrasound images taken after about 4 months of pregnancy.

At birth, a doctor will examine your baby’s feet, arms, hands, hips and legs.

Babies who have a clubfoot are no more likely than other children to have other bone or joint problems, unless they have an underlying condition such as spina bifida or arthrogryposis.

Treating Clubfoot

We treat clubfoot using the Ponseti method. The Ponseti method corrects the problem with minimal surgery, and sometimes with no surgery at all.

  • We begin gently stretching your baby’s foot toward the correct position soon after birth. After about a 1-minute stretch, we apply a cast that extends from the hip to the toes.

    We work with your baby each week, gently stretching the foot farther and applying a new full-leg cast.

    After 4 to 8 weeks of treatment, about 5% to 10% of babies’ clubfeet are completely corrected. Most other babies need a simple procedure in the clinic to release the tight tendon at the back of their ankles (Achilles tendon). These babies wear a final cast for about 3 weeks.

  • After your baby’s foot is in the correct position, they wear a brace nearly all the time for the next 3 months. Then they wear a brace at night and nap times for 3 to 4 years. The brace, made up of leather shoes connected by an aluminum bar, turns your child’s feet outward.

    It is vital to use the brace to make sure your child’s feet stay in the corrected position. Read more about braces and our other orthotics and prosthetics services.

    After this treatment, 2 to 3 children in every 10 will need a minor operation after age 3 to adjust their tendons.

  • Your participation during treatment with the Ponseti method is very important. If the brace isn’t worn as directed, the clubfoot is likely to return. Our doctors and staff are ready to help you with all aspects of the treatment method, including how to care for a baby in casts and braces. We have helped hundreds of families whose children are having Ponseti clubfoot treatment. We are ready to share our expertise and extensive experience with you.

  • About 5% to 10% of babies with clubfoot do not respond to the Ponseti method. These children may need major surgery. We are very experienced in these techniques too.

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information.

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