Clubfoot

About Clubfoot

Clubfoot is a relatively common birth defect, present in about 1 in 1,000 births, in which one or both feet are turned inward, usually to the point that it would appear the person would have to walk on their ankle or side of the foot.

Clubfoot is most often corrected using what is known as the Ponseti Method.  This involves casting for the first several weeks to months of the child's life, changing the cast often as the child grows.  Once the foot has reached the correct position, a brace of some kind is worn for a prescribed length of time.  About 80% of cases require minor surgery at this point, known as a tenotomy, in which the Achilles tendon is "released" by making small cuts on either side and stretching it to lengthen it.  The deformity of the foot is most often caused by the failure of the Achilles tendon to grow to the proper length when forming in the womb.  This type of correction is very successful, but muscles in the foot and leg may always try to turn the foot inward again.  Some cases require surgery again in the future, or braces (usually at night during sleep) to keep the foot corrected.  Sometimes, if a foot deformity is severe, more extensive surgery may be required on other tendons and soft tissues inside the foot.

The Prognosis

Clubfeet usually are corrected and able to grow and form normally as a child grows.  Along the way, interventions may still be necessary to keep the problem from returning.  Few cases have trouble with the foot throughout life.  Most people are able to walk, run, and do everything with no pain as if there was never anything wrong with the foot.  However, those who had extensive surgery may have scar tissue and stiffness and pain in the future.  In most cases, the clubfoot may end up slightly shorter and wider than the normal foot, and even the leg may be a little shorter and the calf muscle slightly smaller.  An encouraging fact to make note of is that there are many celebrity athletes who were born with clubfeet and were very successful in spite of it!  Some of my favorites are Kristi Yamaguchi, Troy Aikman, and Charles Woodson.  Reading success stories like these can be very encouraging to parents, like me, who are going through this with a child.

Our Experience

Our daughter Maggie was born with a clubfoot, her right foot (sometimes I have to think, yeah, it's the right one! lol).  We knew this was a possibility before she was born.   At her 20 week ultrasound, which is the anatomical ultrasound where they check all the body parts to see how they are forming, Dr. Franklin told us it looked like she might have bilateral clubfoot, which is where both feet are clubbed.  She told us a little about it and reassured us that it was correctable so we wouldn't be so scared.  She said we would keep a check on it as she grew to see if it was indeed that or just the way she was laying.  The next check she said she still saw a clubfoot, but possibly only the one.  She also told us this wasn't a 100% diagnosis, because we wouldn't really know until she was born, but we would be prepared.  And on March 16, 2012, when Maggie came into this world, sure enough that little foot was clubbed.  I felt so bad for her, but everyone assured us it didn't hurt her.  I'm thinking, "How would they know that?"  But I understood.  Our pediatrician saw us immediately and called in the orthopedic doctor.  He explained the method of correction to us and had Maggie's leg in a cast before she left the hospital.

To shorten this story, I will just say that Maggie's first cast was too tight and had to be redone, so she had some sore places that scarred her foot, but fortunately now I can't even tell they were there.  People, stay on top of your doctors, because they are human and they aren't always right about everything!  Side note:  Not doctor-bashing, I love all our doctors bunches!  But realistically, we have to take charge of our own care.  Research, research, research!  Read, read, read!  Off my soap box now.  (Caption:  By the way, that picture of Maggie looks bad, but she is as relaxed as can be.  She is under the warmer in the nursery, and the wire is a temp monitor to make sure she doesn't get too hot.  The nurses decided she thought she was in a spa, with all the soaking and warmth and massging! lol)

Maggie and her foot responded well to the casting.  It was a challenge finding clothes to compliment and/or hide, or just fit around or over, the cast during the winter months.  It was also an adventure soaking her in the tub and removing her cast with dull wire cutters at home every 2 weeks!  We would let her leg breathe for one night and one day, then back to the doctor for a new cast.  Once the doctor thought her foot was in the correct position, we got to leave it off and get her a brace to wear on her leg only at night while she was asleep.  This happened when she was about five months old.  We were so happy!  But at about 8 or 9 months, when she hit a growth spurt, we went for an orthopedic checkup and had her first x-rays done.  The news was ok then, but at the next check, her foot had worsened.  The Achilles wasn't stretching enough with the growth of her leg, so he sent us to a specialist in Birmingham, who he highly recommended and had worked on this doctor's own son. 

It did turn out that Maggie had to have the tenotomy...surgery.  I was so heartbroken.  I didn't like the idea of my little baby being put to sleep and cut on!  We took her to Children's for the surgery, early in the morning.  I didn't cry until I got back to our room after seeing her off to the OR.  The surgery was very short, about 30 minutes, and she did great.  She came back a little sickly and upset, of course, but all in one piece!  She had a new cast, and this time, instead of being the white yucky plaster, we got to do the modern cast with colors...PURPLE, of course!  My main concern for her was her mobility.  But just as I suspected, that cast didn't slow her down one bit!  She was crawling and already trying to walk, so she just dragged that thing around with her everywhere she went, even tried to that very day when we got home!  Again, wardrobe was even more of a challenge.  Then after 2 weeks we had to go back and have the cast changed, for which they put her to sleep AGAIN!  About 2 or 3 weeks later, the PINK (this time) cast was removed and she was free!  The doctor said it healed beautifully and her foot looked great.  We did some physical therapy for a while, mostly at home with instruction, and so far, so good.  Maggie did have to wear the Ponseti shoes for a while, which are the old-fashioned shoes with the metal bar between them.  That was not much fun, but she handled it better than I expected.  Eventually, she only wore them at night. 

Maggie outgrew her Ponsetti shoes, then only wore straight last shoes to bed for a while.  Eventually, she did not wear anything on her feet for a while.

 

2015

At her 2 year checkup, after another big growth spurt, the orthopedist told us that her clubfoot was relapsing again.  She was unable to walk with her heel on the ground very often, and the curve was returning to her foot.  She also has a deformed ankle joint, in which the joint is very thick and the outside of the ankle is smooth instead of bony.  This is another cause of the stiffness and lack of fluid motion in her foot.  He recommended another tenotomy, of the Achilles tendon as well as the tendons in her foot, to lengthen them and give her foot more mobility.  Another 6 weeks of casting and we will go from there.