This post is sponsored by Lurie Children’s Hospital, but all of the opinions within are those of The Everymom editorial board.
"Stepping into the world of parenthood is full of surprises and challenges that sometimes make you wish there was a step-by-step guidebook for it all. But as we all know, every kid is their own unique puzzle, and there’s no one-size-fits-all approach to being a parent. This becomes especially clear when your little one is facing obstacles in their health that you’ve never even thought about, such as needing treatment for clubfoot. Suddenly, you’re thrown into this whole new realm of medical lingo and decisions you never imagined making. It’s a lot to take in, but getting clued up on the ins and outs can help you feel more comfortable and confident in navigating the situation at hand.
If your child has been diagnosed with clubfoot and is undergoing medical treatment soon, it’s normal to feel totally overwhelmed by it all. To help you navigate your child’s next steps, we’ve built a resource to answer all your questions with our long-standing partners at Ann & Robert H. Lurie Children’s Hospital of Chicago. We asked their experts in experts in orthopedic surgery and sports medicine to share everything you need to know about the diagnosis and treatment of clubfoot.
Meet the Expert
Rebecca L. Carl, MD
Attending Physician, Division of Orthopaedic Surgery and Sports Medicine
Meet the Expert
Romie Gibly, MD, FAAOS, PhD
Attending Physician, Division of Orthopaedic Surgery and Sports Medicine
What is clubfoot?
Clubfoot is a condition present at birth that can affect one or both feet of a newborn. It’s a foot disorder in which the muscles of the foot are out of balance, and the foot appears curved toward the middle of the body, with toes pointed downward. It’s a condition immediately obvious after birth and is not the same thing as having flat feet or having feet that are turned in. Despite its appearance and name, the affected foot/feet and leg(s) contain all the same bones, muscles, tendons, and anatomic parts as an unaffected foot or leg.
How is clubfoot diagnosed?
In utero diagnosis
Clubfoot can often be diagnosed by ultrasound (sonogram) examination before birth. Approximately 10 percent of all clubfeet can be diagnosed by 13 weeks’ gestation, and about 80 percent can be diagnosed by 24 weeks’ gestation. However, diagnosis based on ultrasound alone produces a 20 percent false positive rate, which is because the normally shaped foot sometimes turns inwards momentarily as the baby wiggles his toes and feet, and if an ultrasound picture is made at that instant, the foot can have an atypical appearance.
Post-birth diagnosis
Once your baby is born, doctors typically diagnose clubfoot using physical examination. The team at Lurie Children’s approaches each child and family individually, acknowledging the unique needs of each limb disorder when coming up with a comprehensive plan for treatment.
What is the typical treatment path for clubfoot?
After a fetus is diagnosed with clubfoot, parents who are seeking care at Lurie Children’s will have the opportunity to meet with a team of specialists to learn about what to expect when their baby is born. The condition is correctable after birth, and no intervention is done before delivery. If they wish, parents can meet with an orthopaedic specialist before their baby is born to discuss how the stretching and casting are done. Parents are asked to bring their infants for evaluation in the first few weeks after birth.
Lurie Children’s Division of Orthopaedics and Orthotics and Prosthetics Department follows the Ponseti Method, which is the most recognized approach to treating clubfoot worldwide. The method includes the following three phases:
Casting
The baby’s affected foot and leg will be placed into a plaster cast from the top of the leg to the toes, with the toes left open. Each week, for about five or six weeks, the cast will be removed, and doctors will gently stretch your baby’s foot closer to a normal position, then put on a new cast to hold the stretch in place.
Since most infants do not move around very much in the first weeks of life, they do not have too much difficulty or discomfort in the casting phase. Casting is usually started in the first six weeks of their life, but treatment can be successful even if it is started later. On average, infants with clubfoot require five or six casts, although this can vary.
Achilles Tendon Release
The majority of children with clubfoot require this brief outpatient procedure (also called an Achilles tenotomy) after five to seven weeks of casting. With one stroke, the orthopedic surgeon makes a small incision in the Achilles tendon, located at the back of your baby’s heel. When the tendon releases, it lengthens and allows the foot to move more easily up and down at the ankle. Sutures or stitches are not usually needed to heal, and the achilles tendon typically heals within 2-3 weeks of the tenotomy.
A new cast is then placed on the foot and lower leg immediately following the procedure. Worn for two or three weeks, this cast holds the new position of the foot and aids healing. Most babies feel no pain or a little pain, which tends to go away very quickly on its own or with a little bit of acetaminophen.
Bracing
In this phase, the feet are braced and an orthotic team collaborates with a physician to ensure there is a smooth transition from casting to bracing. There are several varieties of braces, which consist of two shoes connected by a bar. Both of the child’s feet are braced, even if the clubfoot is only on one side.
Young infants wear the brace full time (except while bathing) for about three to four months, and after that, they gradually switch to wearing it for 12 to 14 hours (at night and during naps) until they are 4 or 5 years old.
Your child may require some time to adjust to the brace, but it is very important to keep a consistent schedule and encourage a positive attitude with bracing. Your orthotist and doctor can provide tips or make necessary adjustments to braces as needed. Throughout this phase, your child will return to the clinic regularly—every three months until they are walking well, and then for return visits every six months until the age of 5. After age 5 or 6, the frequency of visits decreases.
Using a bar-and-shoe brace is the most important way to prevent clubfoot from coming back. Research has shown that the recurrence rate decreases dramatically when children consistently wear their brace as prescribed.
Why is early treatment important for a successful outcome?
Early treatment for clubfoot is important because it can improve long-term outcomes, reduce the need for surgery or multiple surgeries, minimize pain and discomfort, and sometimes improve psychological well-being for children. When the majority of treatment is completed before school age, the most successfully treated children will not need daytime braces, special shoes or accommodations by the time they are in kindergarten.
Advice for parents going through the treatment process
It is completely expected for the treatment process to feel overwhelming and a bit stressful at times for several reasons. Some of the more common concerns include whether the chosen treatment plan will effectively correct the deformity and ensure proper function, worrying about your child’s comfort during treatment, especially with procedures like casting or surgery, and wondering if the deformity will cause pain or restrict mobility in the future depending on the severity of the case. Here are ways to manage these fears and concerns to make the experience feel as manageable as possible:
- Understand your fears and address them: It’s perfectly normal to feel anxious about your child’s upcoming treatment. However, it’s important to talk to your doctor about your specific concerns. The more informed you are about the treatment plan, potential risks, and expected outcomes, the better equipped you’ll be to handle the situation.
- Focus on the long-term benefits: While months of treatment might seem daunting, remember it’s aimed at improving your child’s health and well-being in the long run. The surgeon can explain the potential benefits of the treatment and how it will positively impact your child’s future.
- We’re here to support you: The medical team, including surgeons, nurses, and therapists, are there to guide you through every step of the process. They’ll answer your questions, address your concerns, and work together to ensure the best possible outcome for your child.
- Remember, you’re not alone: Many children go through similar treatment plans. There are resources available, and the medical team can provide you with local support groups to connect with. Ultimately, the best thing you can do is focus on your child’s well-being and trust that the treatment will lead to a positive outcome.
How can parents best support their child throughout the treatment process?
You may be concerned about how your child will be emotionally affected by a diagnosis and treatment process, which is completely normal and expected. Whether it’s worrying about how their peers will treat them, feeling stressed about the possibility of them being unable to participate in certain physical activities, or being generally concerned about their mental health throughout the treatment process, there are so many ways to be there for your child and let them know that they are not going through this alone.
Above all, open communication is key. Talk to your child about the treatment plan in an age-appropriate way and encourage them to ask questions and express their feelings. Also, keep the communication channels open with the medical team. Don’t hesitate to voice any concerns or ask for clarification whenever needed. The best thing you can do as a parent is to do your best to check in with your child and everyone involved in their treatment as regularly as you can.
About Ann & Robert H. Lurie Children’s Hospital of Chicago
Led by a team of world-renowned pediatrics experts, Lurie Children’s is the #1 pediatric hospital in Illinois and an institution we trust for all things kids’ health. With 140 years of clinical expertise, research, and community engagement, the team at Lurie Children’s is committed to putting children and their families at the center of everything they do. We are honored to partner with Lurie Children’s to help educate our readers about how we can help our kids lead a healthier future. Learn more about Lurie Children’s and find a doctor near you today!
This post was in partnership with Ann & Robert H. Lurie Children’s Hospital of Chicago, but all of the opinions within are those of The Everymom editorial board.