Medicines for Clubfoot

What it is

Clubfoot (also called talipes) is a condition, present from birth, in which a baby is born with a foot (or both feet) turned inwards and downwards, so that the sole of the foot points inwards or upwards rather than flat on the ground. It is one of the more common conditions present at birth affecting the feet. The foot and lower leg may look twisted or turned, and the affected foot and calf may be somewhat smaller than usual. In most cases, clubfoot occurs on its own, without any other condition (isolated clubfoot), and the exact cause is often not known, though it can run in families; less commonly, it can be associated with other conditions. Clubfoot is usually detected either during pregnancy (on an ultrasound scan) or at birth, when the shape of the foot is apparent; it is not painful for the baby, but if left untreated, it would affect the child’s ability to walk normally and could cause problems, so it is treated. The very reassuring and important point is that clubfoot is very treatable, and, with modern treatment, the great majority of children with clubfoot go on to have functional, painless feet and to walk, run, and play normally, wearing ordinary shoes. The main treatment is a well-established, non-surgical method (the Ponseti method), which involves gently manipulating and stretching the foot into a better position and holding it with a series of casts (usually changed weekly over a period of weeks), often followed by a minor procedure to release the tight tendon at the back of the ankle, and then wearing special boots and a bar (a brace) for a period (initially much of the time, then at night and nap times) for some years, to hold the correction and prevent the clubfoot returning. This treatment is very effective. Occasionally, more treatment or, in some cases, surgery may be needed. The key messages are that clubfoot is a common condition where a baby is born with a foot turned inward and downward, that it is very treatable (usually with the non-surgical Ponseti method), and that most children go on to walk and play normally.

How it is treated

Clubfoot is very treatable, usually with the non-surgical Ponseti method (manipulation, casting, and bracing), with most children achieving functional, painless feet and walking normally; treatment usually begins soon after birth. Clubfoot is often detected before birth (on an ultrasound scan, which allows the family to receive information and be prepared) or at birth. Once identified, the baby is referred to specialists (such as paediatric orthopaedic teams), and treatment usually begins in the first weeks of life. The main and highly effective treatment is the Ponseti method, which is well-established and largely avoids the need for major surgery: it involves gently manipulating and stretching the foot into a more correct position and holding it with a plaster cast, with the cast usually changed and the foot gradually corrected over a series of weekly casts (over a period of weeks); this gradually moves the foot into a good position. In most cases, a minor procedure is then done to release the tight tendon at the back of the ankle (the Achilles tendon), which helps complete the correction; this is a small procedure. After the correction is achieved, the crucial next phase is bracing (wearing special boots attached to a bar) to hold the foot in the corrected position and prevent the clubfoot from returning (relapsing) — the brace is worn for much of the time at first, then reduced to night-times and nap times, and continued for some years (often up to around the age of four or five); wearing the brace as advised is very important, as not doing so is a common cause of the clubfoot coming back. With this treatment, the great majority of children do very well, with functional, painless feet, and are able to walk, run, and play normally in ordinary shoes. The foot and calf may remain slightly smaller, but this does not usually cause problems. Follow-up monitors the foot and checks for any relapse, which, if it occurs, can be treated. Occasionally, some children need additional treatment, and, in a minority of cases (particularly more severe or resistant clubfoot, or clubfoot associated with other conditions), surgery may be needed. Support and clear information for the family, and support organisations, help, particularly as the treatment (especially the bracing phase) requires commitment over time. The reassuring messages are that clubfoot is very treatable, usually with the non-surgical Ponseti method (manipulation, casting, a minor tendon procedure, and then bracing to prevent relapse), that most children go on to have functional, painless feet and to walk and play normally, and that wearing the brace as advised is key to preventing relapse; so early treatment with the Ponseti method, and adherence to the bracing, are the keys to managing clubfoot.