What is clubfoot?
Clubfoot, also called clubfoot, is a congenital deformity of the foot that appears as early as the 20th week of gestation.
At birth, the foot has a characteristic downward deviation (equinus) and the sole is turned upwards (varus). From the medical point of view, the foot is equinovarus but with a cavus component (arch fold) and adductus (toes inward).
It is a rigid deformity so that it is not possible to place the foot in a normal position.
Its frequency is approximately 1 per thousand children, 50% of the cases are bilateral and it is twice as frequent in boys than in girls.
What is the cause of this pathology?
We know that the deformity occurs because the muscles, tendons and ligaments of the back and inside of the leg are denser and less elastic than normal. During the growth of the fetus in utero, these structures become short and cause the foot to become progressively deviated. The posture in which the foot is placed is so abnormal that the arrangement and shape of the bones of the foot is altered.
In some cases clubfoot is associated with known neuromuscular diseases, but in most cases we do not know why these tissues are so dense and so inelastic.
How and when is it diagnosed?
Since this congenital malformation occurs during the first months of gestation, it is usually possible to visualize it in the ultrasound study of the 20-week fetus, so prenatal diagnosis of suspicion is becoming more and more common.
Confirmatory diagnosis is easy after birth, observing the shape of the foot downward (equinus) and inward (varus) and verifying that by manipulation we are not able to obtain a normal position.
Experience is needed to distinguish it from other congenital foot malformations such as congenital vertical talus, and from some deformities with a much better prognosis such as metatarsus adductus or talus foot. It is also important to rule out the existence of other neuromuscular diseases.
How can it be treated?
The most commonly used treatment consists of progressive correction with casts and maintenance of the correction with boots according to the method described by Dr. Ponseti. For this purpose, casts are placed at maximum correction and are changed every week until complete correction is achieved. In general, three to five cast changes will correct all aspects of the deformity except for the equinus position (tiptoe) and therefore a small procedure, percutaneous lengthening of the Achilles tendon, is usually necessary. This is usually performed under local anesthesia and then the final cast is placed for three weeks while the lengthened tendon heals.
As the deformity has a great tendency to reproduce, after the normal posture of the foot is achieved, we place a small device (abduction splint) that keeps the feet in the correct posture. This apparatus is made up of a pair of small boots turned outwards and a bar that joins them together. In fact, it is a dynamic system that, in addition to maintaining the posture, favors correction when the child flexes the knees. The appliance is worn for about four months around the clock (although it is taken out for bathing and dressing) and then kept on only when the child is asleep (napping and at night) until the child is four years old.
Can it leave sequelae?
The results obtained at the end of the treatment are generally good and the child can perform all types of physical activities without limping or disability.
The malformation itself usually results in a smaller foot (generally one centimeter) and calf (about one centimeter thinner). If the child has both feet affected, it is not usually recognized, but if the child has only one foot deformity, a slight asymmetry will be perceived. Only in some cases there may be a smaller first toe or a slightly shorter leg, generally without functional repercussions.