Clubfoot describes a range of foot abnormalities that children can be born with. A baby's foot is twisted inward and is out of shape or position. With clubfoot, the tendons (tissues that connect muscles to the bone) are shorter and tighter than usual, pulling the foot in this abnormal position. The term 'clubfoot' refers to the way the foot is shaped, like the head of a golf club. Clubfoot is a fairly common birth defect and is usually an isolated problem in an otherwise healthy newborn. Clubfoot can be mild or severe. About half of children with clubfoot have it in both feet.
If your child has clubfoot, his or her foot may have the following appearance:
o The top of the foot is usually twisted downward and inward, increasing the arch and turning the heel inward;
o The foot may be turned so severely that it actually looks like a backward C or even upside down;
o The calf muscle in that leg is usually small or underdeveloped;
o Because of the curve, the clubbed foot may be up to a 1/2 inch (about 1 centimeter) shorter than the other foot.
More than likely your pediatrician will notice the clubfoot soon after your child is born.
The cause of clubfoot is unknown. But scientists do know that clubfoot is not caused by the position of the baby in the womb during pregnancy. In some cases, clubfoot can be associated with other abnormalities that are present at birth, such as spina bifida (a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube). Studies have linked clubfoot to cigarette smoking during pregnancy, especially when there already is a family history of clubfoot.
Risk factors include sex.

Clubfoot is more common in males.
o Family history: If either one of the parents or their other children have had clubfoot, the baby is more likely to have it as well. It's also more common if the baby has another birth defect;
o Smoking during pregnancy: If a woman with a family history of clubfoot smokes during pregnancy, her baby's risk of the condition may be 20 times greater than average;
o Not enough amniotic fluid during pregnancy: Too little of the fluid that surrounds the baby in the womb may increase the risk of clubfoot;
o Getting an infection or using illicit drugs during pregnancy. These can increase the risk of clubfoot as well.
Complication
Despite how the foot looks, clubfoot is not usually painful. If your child has clubfoot, it will make it hard for him or her to walk normally. He or she may have some difficulty with finding shoes due to shoe size. The affected foot may be up to one-and-a-half foot shoe sizes smaller than the unaffected foot. However, if not treated, clubfoot causes more serious problems. These can include:
o Arthritis: Your child is likely to develop arthritis;
o Poor self image: The unusual appearance of the foot may make your child's body image a concern during the teen years;
o Inability to walk normally: The twist of the ankle may not allow your child to walk on the soles of the feet. To compensate, he or she may walk on the balls of the feet, the outside of the feet or even the top of the feet in severe cases;
o Muscle development problems: These walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the feet and result in an awkward gait.
Diagnosis
Most commonly, a doctor recognizes clubfoot soon after birth just from looking at the shape and positioning of the newborn's feet. Occasionally, the doctor may request X-rays to fully understand how severe the clubfoot is, but usually X-rays are not necessary.
It's possible to clearly see some cases of clubfoot even before birth during a baby's ultrasound examination. If clubfoot affects both feet, it's more likely to be seen in an ultrasound. While nothing can be done before birth to solve the problem, knowing about the condition may give you time to learn more about clubfoot and get in touch with appropriate health experts, such as a genetic counselor or an orthopedic surgeon.
Treatment
Because your newborn's bones and joints are extremely flexible, treatment for clubfoot usually begins in the first week or two after birth. The goal of treatment is to improve the way your child's foot looks and works before he or she learns to walk, in hopes of preventing long-term disabilities. Treatment options include stretching, bracing and maybe even surgery.
Stretching and casting (Ponseti method) is the most common treatment for clubfoot. The doctor will do the following:
o Move the baby's foot into a correct position and then place it in a cast to hold it in that position;
o Reposition and recast the baby's foot once or twice a week for several months;
o Perform a minor surgical procedure to lengthen the Achilles tendon (percutaneous Achilles tenotomy) toward the end of this process.
After the shape of the foot is realigned, parents will need to maintain it by doing one or more of the following:
o Doing stretching exercises with your baby;
o Ensure your child wears special shoes and braces;
o Ensure your child wears the shoes and braces as long as needed -- usually full-time for three months, and then at night for up to three years. For this method to be successful, you'll need to apply the braces according to your doctor's directions so that the foot doesn't return to its original position. The main reason that this procedure sometimes doesn't work is because the braces are not used constantly or for as long as needed.
Stretching and taping (French method) is another method of stretching the foot to help straighten it. Usually this is ordered by the doctor and carried out by the physical therapist and parents. It is done by moving the foot daily and holding it in position with adhesive tape, or by using a machine to continuously move the baby's foot while he or she sleeps. After two months, treatment is cut back to three times a week until the baby is six months old. Once the shape is corrected, daily exercises must be continued along with use of night splints until the baby is of walking age.
Surgery
Doctors are usually able to treat clubfoot successfully, though sometimes a small number of children may need surgery if clubfoot is severe or doesn't respond to nonsurgical treatments. The tendons will need to be lengthened to help ease the foot into a better position. After surgery your child will be in a cast for up to two months and then need to wear a brace for a year or so to prevent the clubfoot from coming back. Even with treatment, clubfoot may not be totally correctable. But in most cases, babies who are treated early grow up to wear ordinary shoes and lead normal, active lives without pain.
o For more information or if you think your child may have clubfoot, visit www.apma.org or www.mayoclinic.com or email us at Foothealth242@gmail.com. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street or call 325-2996 for an appointment or Bahamas Surgical Associates on Albury Lane or call 394-5820/4 for an appointment.

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