What is it?
Clubfoot is a congenital malformation of one or both feet consisting of a torsion of the foot around its longitudinal axis. The foot/feet appear rotated inward with their tips downward.
What are the causes?
The causes of this deformity are unknown and several theories have been developed to explain its pathogenesis (mechanical theory: mal-positioning of the foot in the maternal uterus; neuromuscular theory: damage of the peroneal nerve and / or alteration of the peroneal muscles; embryogenetic theory: neural tube defects and genetic diseases-chromosopathies)
How can it be diagnosed?
In most cases diagnosis is prenatal through mother’s ultrasound during pregnancy, allowing families to prepare but also, begin treatment immediately after birth.
Otherwise diagnosis is performed clinically immediately after birth.
How can it be treated?
Treatment should start as soon as possible. Physiotherapy and manipulation are indicated in cases of mild clubfoot, while in case of moderate deformity custom made foot leg braces and shoes can be used.
In case of severe deformity treatment according to the Ponsetti method is indicated, consisting in serial plaster casting renewed every 2 weeks approximately for a minimum of 5-6 plasters, associated to Achilles tendon tenotomy. The aim is to achieve an early correction of deformity avoiding bony deformation that may require more invasive surgery.
What happens if not treated immediately after birth?
If left to itself congenital clubfoot causes an altered support of the foot with consequent difficulty / impossibility on walking and standing.
Is there any recurrence during growth?
Yes. Since it is a congenital malformation clinical follow up is recommended during the entire growth period to verify the correct development of the foot.
In case of recurrences and/or improper development of the foot during child’s growth surgical procedures on soft tissues (anterior tibialis transfer, release of the plantar fascia) and/or on bones (osteotomies) may be indicated to ensure a plantigrade support of the foot itself.