Clubfoot, also known as congenital talipes equinovarus , is a fairly common birth defect. It occurs in about one out of every 750 to 1,000 live births. This defect can occur in one or both feet.

About twice as many boys are affected than girls are. The most severe form of clubfoot is characterized by the foot or feet being turned inward and pointed downward. When both feet are clubbed, the toes turn toward each other. 

Clubfoot is usually an isolated defect. Only about 10% of babies with clubfeet have any other associated birth defect. There are two general categories of clubfoot — intrinsic and extrinsic. 

• Intrinsic clubfoot is described as:
   
  • Rigid at birth with atrophy (not as well developed)
  • Fibrosis (stiffness)
  • Abnormal bone position
• Extrinsic clubfoot means the foot is flexible at birth, although the bones are out of position.

We do not know what causes clubfoot. We do know it is not related to anything the mother ate or did during pregnancy.

Clubfoot is not painful for your baby. It really has no effects on your newborn. However, it does need to be corrected, as it will not resolve on its own. Your child will not be able to walk normally with untreated clubfoot because they will not be able to place the affected foot (or feet) flat on the floor.

This method did not gain popularity until the babies who were first treated grew up and proved that this method provides better results than the traditional surgical method does.

The Ponseti Method is a multi-step, multi-visit process that begins shortly after birth, when the tendons are more flexible.

Steps in the Ponseti Method

1. At first, doctors gently massage and manipulate the clubfoot. This stretches and contracts the tissue.
2. Following the massage and manipulation, doctors place a thin plaster cast (or casts), with the foot (or feet) positioned in the more stretched position. The cast extends from the toe to the groin.
3. Doctors change the cast(s) every five to seven days. With each casting, doctors repeat the massage and manipulation and apply a new cast to the stretched foot. This process typically continues for five or six casting sessions.
4. Before doctors apply the last cast, 90-95% of these babies will require a tenotomy. This procedure releases or cuts the Achilles tendon to help correct the clubfoot deformity. Some surgeons will do the tenotomy in the clinic if the clubfoot is only on one side, but most of the time, the tenotomy is done in the hospital under general anesthesia for the comfort of the patient. It is outpatient surgery and the child will go home the same day.
5. Once doctors have removed the final cast, they fit the children with a special type of splint. This splint includes a pair of shoes connected to each other by a metal bar attached to the bottom of the shoes. The shoes are rotated away from the body. The child must wear the splint for 23 hours a day for three months and then at night and during naps (10-12 hours per day) for the next two to four years.

Reported success rates with the Ponseti Method vary greatly. Doctors successfully correct approximately 50-90% of children with clubfeet without surgery. However, some babies have short, fat feet with stiff ligaments that will not yield to stretching and may require some type of surgery. If surgery becomes necessary for your child, their orthopedic surgeon will explain what type of procedure should be performed.

The Fetal Concerns Center can schedule a meeting with the orthopedic doctor before your baby is born. Meeting with an orthopedic surgeon will help you get a better idea of how your baby's clubfoot can be treated after delivery. You will meet the doctor and their nurse who will be most involved in the care of your baby after birth.

Yes. If your baby is born with clubfoot and no other problems, they will likely go to the newborn nursery. In most cases, you can visit the nursery and have your baby brought to your room. 

If you deliver at Froedtert Birth Center, an orthopedist may see your child in the hospital. 

If you do not deliver here, or the orthopedist does not see your baby before they go home, please call to set up the first casting appointment as soon as possible after you take your baby home. For best results, we will need to do the casting as soon after birth as possible.

Yes, you should be able to breastfeed your baby. If you do plan to breastfeed, a lactation consultant can answer any questions you may have. You may want to discuss how to position your baby for feeding if they have long leg casts. 

More than likely, your baby will go home when you leave the hospital unless they have other issues that require more intensive treatment or more assessment.

The long-term prognosis for babies with clubfoot who are treated with the Ponseti Method is excellent. Historically, they have had almost no difference in function or pain in their feet than people who were born without clubfoot. The only known issues that can cause increased pain are related to excessive weight gain and working jobs that require a lot of time standing.

Learn more about the Orthopedics Program at Children's Wisconsin.