Birth defects

• Birth defects can cause disabilities and even death.
• Alcohol and drug use while pregnant can cause birth defects.
• Ask your provider what you can do to prevent birth defects.

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Clubfoot (also called talipes equinovarus) is a birth defect of the foot. Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops or in how the body works.

If your baby has clubfoot, one foot or both feet point down and turn in. This happens because the tissues that connect muscles to bone (called tendons) in your baby’s leg and foot are shorter than usual. This pulls the foot into an abnormal position. Babies with clubfoot also may have abnormal foot bones, ankle joints and muscles.

Clubfoot is a common birth defect. About 1 in 1,000 babies is born with clubfoot in the United States each year.

What problems does clubfoot cause?
Clubfoot can range from mild to serious. Clubfoot isn’t painful, and it doesn’t bother your baby until he begins to stand and walk. If it’s not treated, he may have problems walking correctly. For example, he may walk on the sides of his feet or even on the tops of his feet instead of on the bottoms or soles of the feet. Sometimes, the part of the foot he walks on abnormally can get infected, and the skin can get thick and hard. Clubfoot that’s not treated can cause arthritis. This is a health condition that causes joint pain, aches, stiffness and swelling.

How do you know if your baby has clubfoot?
Your baby’s provider can identify clubfoot and other foot problems in a physical exam of your baby after birth. Your baby’s provider may use other tests, like a foot X-ray.

Sometimes, your health care provider may see that your baby has clubfoot before birth using ultrasound. An ultrasound uses sound waves and a computer screen to make a picture of your baby in the womb. Even though clubfoot can’t be treated until your baby is born, knowing about it while you’re pregnant may help you plan ahead for treatment.

How is clubfoot treated?
A doctor with special training in bone conditions called an orthopedic surgeon can help you understand the best treatment for your baby. Until recently, many children with clubfoot had surgery to correct their condition. Now, most children with clubfoot can be treated without surgery. Treatment works best when it’s started early, even as early as 1 week old. With early treatment, most children with clubfoot can grow up to wear regular shoes and have active, normal lives.

Clubfoot treatment may include: 

• Stretching and casting (also called the Ponseti method). This is the most common treatment for clubfoot. It usually starts in the first 2 weeks of your baby’s life.For this treatment, your baby’s provider stretches your baby’s foot toward the correct position and then puts it in a cast. The cast goes from your baby’s toes to his upper thigh. Every 4 to 7 days, your baby’s provider takes off the cast, moves your baby’s foot closer to the correct position and puts on a new cast. Before your baby gets his last cast, his provider may cut the heel cord. This is the tendon that connects the heel to muscles in your baby’s calf. This allows the heel cord to grow to a normal length by the time the last cast comes off.This type of treatment usually fixes the problem in 2 to 3 months. After that, your baby can do  stretching exercises to help keep his feet in the right position. He also may need to wear special shoes or a brace at night for a few years. 
• Stretching, taping and splinting (also called the French method). With this treatment, your baby’s provider stretches your baby’s foot toward the correct position and uses tape and splints to hold it that way. This treatment usually starts soon after birth and is done every day for 2 months and then less often until your baby is 6 months old. After this, you can use stretching exercises and night splints to help keep your baby’s feet in the right position until she starts to walk.
• Surgery. If your baby’s clubfoot is severe or if stretching treatments don’t work, clubfoot can be treated with surgery. It’s best to have surgery before your baby starts walking. Surgery can help make the heel cord longer and fix other problems with the feet. After surgery, your baby may be in a cast for 6 to 8 weeks.

What causes clubfoot?
We don’t know what causes clubfoot, and there’s no way to prevent it. But some things may make a baby more likely than others to have the condition, including:

• Your baby is a boy. Boys are twice as likely as girls to have clubfoot.
• Your baby has another birth defect, like cerebral palsy or spina bifida.
• You have clubfoot in your family health history. This is a record of any health conditions and treatments that you, your partner and everyone in your families have had. If you, your partner or one of your children has clubfoot, your baby’s risk of having clubfoot increases. If you already have a baby with clubfoot, your chances of having another baby with the condition is about a 2 in 50 (about 4 percent). You can talk to a genetic counselor to help you understand the chances of having another baby with clubfoot. A genetic counselor is a person who is trained to know about genetics, birth defects and other medical problems that run in families.
• You have oligohydramnios during pregnancy. This is when you don’t have enough amniotic fluid. This is the fluid that surrounds your baby in the womb.
• You have an infection or use street drugs or smoke during pregnancy. Don’t smoke or take street drugs during pregnancy.

Last reviewed January 2013

See also: Your family health history, Genetic counseling