Expert / 29 September, 2021 / My Baba
Clubfoot, also known as talipes equinovarus, is a highly treatable congenital birth defect that results from abnormal development of the muscles, tendons, and bones of the foot.
More commonly found in males, clubfoot causes one, or both feet in around half of cases, to turn inwards and upwards and become rigid because of a tight Achilles tendon (the large tendon found at the back of the ankle).
While clubfoot can range from mild to severe, the same general appearance is consistent throughout most cases. And nearly all cases occur in babies who are otherwise healthy—the position of their feet being the only medical barrier to an excellent quality of life.
Recent studies have shown that clubfoot occurs in 1 out of every 600 to 800 births, and has been documented for thousands of years, with some variation across countries and ethnic groups and an increased incidence in children born to a parent with clubfoot. Its exact causes are largely unknown, but research indicates that genetic factors may play a role in 25% of cases.
Despite such a large number of children being born with clubfoot, people in the UK are still largely unfamiliar with the condition due to the advanced healthcare system. But, more recently, British Open golfer Jon Rahm, Love Island Star Hugo Hammond, and medal-winning Paralympians Jonathan Broom-Edwards, Fin Graham, and Laura Sugar have put the topic of clubfoot into the spotlight, after openly discussing their own personal experiences of being born with the condition.
Clubfoot can often be diagnosed during a prenatal ultrasound and is usually spotted by doctors in routine scans between 18 and 21 weeks of pregnancy. However, even if a child is not diagnosed with clubfoot prior to birth, this condition can be quickly recognised by medical professionals as soon as they are born by simple physical examination.
Rarely are complex tests, such as x-rays, CT scans, or CAT scans, required to confirm the diagnosis, unless there are suspected additional health complications. On occasion, an x-ray may be used to examine the severity of the clubfoot.
Either way, receiving this early diagnosis can be valuable for parents, giving them a chance to discuss next steps with their doctor and time to put plans in place for treatment prior to the birth of the child.
Of course, treating clubfoot can be a long and involved journey for parents, so building a strong relationship with the doctor can also help to ease some of parents’ anxiety. These professionals will guide parents through the process and offer their expert advice on any questions and challenges that arise.
Although receiving a diagnosis of clubfoot may come as a shock, don’t panic! The good news is that more than 95% of children who are treated early can experience active, healthy lives, with minimal if any lasting effects. You might be thinking, “I’ve never seen anyone with clubfoot”— that’s because it is so treatable. If you live in the UK or a country with advanced medical care, the odds that your child will experience significant impairment from clubfoot are close to zero.
Regardless of the severity of a child’s clubfoot, the condition will not improve without treatment. The aim of treatment is to ensure the child has a functioning foot and can stand and walk with the sole of their foot flat on the ground. The ultimate goal of treatment is to give the child pain-free mobility.
The preferred treatment, known as the Ponseti method, involves casting for 6-8 weeks to gently reposition the feet, followed by a simple procedure that releases the Achilles tendon. Finally, infants wear a foot abduction brace to prevent relapse—for 23 hours a day for the first three months, then only when sleeping for several years.
A medical professional will advise on the exact amount of time a brace should be worn. Numerous studies, including MiracleFeet’s own data, show consistent bracing is the most likely factor determining long-term success. However, it is important that families are highly committed to wearing the brace everyday—until their doctor says otherwise–to prevent relapse. Making this part of the child’s everyday routine is critical to long-term results.
Ideally, treatment should begin within weeks of birth when the tendons and ligaments are at their most elastic. Without this early intervention, as the child begins to walk, they will bear weight on the side of the foot which will cause further twisting. This often causes the child discomfort and can increase the likelihood of surgical intervention to correct clubfoot, if left untreated.. Surgery is considerably more invasive and complex than the Ponseti method and can lead to increased pain, stiffness, and the need for additional operations throughout the person’s life.
However, in healthcare systems like the UK, early diagnosis means children are usually treated immediately after birth, significantly reducing their chances of experiencing any long-term mobility issues. This means they will have feet that allow for an active, healthy life.
Unfortunately, today, what most people don’t realize is that 90% of children with clubfoot are born in low- and middle-income countries where few receive proper care. Children living with untreated clubfoot are more likely to experience severe disability, chronic pain, stigma and discrimination, exclusion from education and community life, and higher rates of neglect and abuse.
Despite the fact that clubfoot is one of the most common birth defects and a significant cause of preventable disability, the condition has been largely overlooked by major global health and development initiatives. As a result, about two million children today, who were born with clubfoot, live with its severe disability.
MiracleFeet is the largest global nonprofit organization working to ensure that every child born with clubfoot has access to the medical care they need to thrive. Founded in 2010, MiracleFeet has already helped 60,000 children across 29 countries. Through partnerships with local healthcare providers, they work to bring the Ponseti method, the standard of care provided in advanced healthcare systems, to countries lacking adequate access to this inexpensive treatment—costing only 350 GBP per child on average. With the help of MiracleFeet, this care is either free or very low-cost for the families who require it.
Article by Chesca Colloredo-Mansfeld, CEO and co-founder of MiracleFeet – the leading global children’s nonprofit organization on a mission to eliminate untreated clubfoot worldwide. For more information on MiracleFeet’s global work, please visit https://www.miraclefeet.org/.