Clubfoot: signs, causes and treatment with the Ponseti method

Clubfoot, also called talipes, is a condition present from birth in which one or both feet are curved into an unusual position. The NHS says it is uncommon and that treatment usually works well if it is started soon after birth.

The NHS says it is usually not known why a baby has clubfoot, though an altered gene passed on from parents can sometimes explain it, and it is sometimes linked to another health condition such as spina bifida or Edwards' syndrome (trisomy 18).

According to the NHS, if your baby has clubfoot their foot might be bent and curved, point inwards, up or down, and feel stiff and tight if you try to gently move it. Clubfoot can make 1 or both feet curve inwards and downwards.

It is not always clubfoot. The NHS says that sometimes a baby has signs of clubfoot but their feet move into a normal position over time without any treatment. This is called positional talipes, and a specialist will tell the two apart.

The NHS says clubfoot may be noticed during pregnancy, or it may be diagnosed after your baby is born. After the birth, if a healthcare professional thinks your baby has clubfoot, they will refer them to a foot clinic or a doctor who specialises in children's muscles and bones (a paediatric orthopaedic specialist). The appointment should happen within a few weeks of the birth.

At the appointment the specialist may see and feel your baby's feet, look at and feel other areas such as the legs, hips and spine, and ask whether anyone in your family has had clubfoot or other health conditions. They may also arrange an ultrasound scan or X-ray of your baby's hips, legs or feet.

The NHS says treatment usually involves the Ponseti method, done in 3 stages.

The boots and bar stage can be the hardest for families, because it goes on for years. The NHS stresses that it is important to follow the treatment plan agreed with the clubfoot clinic: if your child does not wear their boots and bar for as long as they need to each day, their foot may not stay in the healthy position.

Your child will have appointments with the clubfoot clinic during this time, and the clubfoot care team can answer questions and offer support if you need it.

The NHS says treatment usually works well if it is started soon after birth. That is why the first specialist appointment is arranged within a few weeks of birth, and why casting starts when the baby is a few weeks old.

Steps Charity Worldwide says studies show that treatment of clubfoot by the Ponseti method is very effective if the protocol is followed closely. Sometimes clubfoot can come back, which is called a relapse. It says relapses are estimated to occur in 1 or 2 out of every 10 cases, that continuing with boots and bar reduces the incidence of relapse to 15 to 20%, and that not wearing the brace as advised has been linked with a relapse rate of up to 60%. It adds that there is evidence of a higher relapse rate in children with syndromic (non-idiopathic) feet.

Steps says one of the first signs of relapse is loss of dorsiflexion, the movement of lifting the foot upwards, which can result in walking on the toes or being unable to get the heels flat on the floor, and that it may become difficult to get the feet down fully into the boots and bar. If this happens, tell the clubfoot team.

Treatment of a relapse depends on severity. Steps says that if the relapse is related to problems keeping boots and bars on for the recommended time, addressing that may be enough. For more severe relapses a clinician may need to manipulate the feet and reapply a plaster cast, followed by a repeat of the boots and bars stage. In some cases surgery, such as a tendon transfer, is needed, followed by about 6 weeks in a plaster cast.

The NHS suggests it may be helpful to get support from other parents and carers with a child who has clubfoot. It points to the charity Steps Charity Worldwide, which offers information and support for anyone affected by childhood lower limb conditions, including clubfoot.

The care team at your hospital can also put you in touch with local services, and your health visitor and GP can help with questions about development and walking.

On the NHS, clubfoot is usually picked up on a scan in pregnancy or at the newborn check, and treated in a specialist foot clinic or paediatric orthopaedic service. Because treatment works best when started early and is delivered as a weekly programme, most families use the NHS service closest to them. Some families seek a private opinion from a paediatric orthopaedic surgeon, and the Ponseti method is the same standard approach in both settings.