Club Foot & Congenital Deformity

Congenital deformities of the lower limbs are the developmental disorders which are present at birth and cause alteration in the shape and appearance of the legs. The exact cause for this is not known. There are several factors such as genetic factors which influence the fetal growth in the womb and teratogenic drugs and chemicals that can cause congenital deformities.

Congenital clubfoot is the most common and obvious of all the pediatric foot deformities. The feet become twisted inwards in such a way that the top of the foot comes in place where the bottom should be and is twice as common in males. The foot appears turned downwards and inwards. The calf muscle and foot may be smaller than normal. The heel is flexible and softer and is rotated inward making the soles of the feet face each other when both feet are involved.

Diagnosis of pediatric foot deformities involves gathering information about the symptoms and the duration for which the deformity is present and a thorough physical examination of the foot and ankle. X-ray of the foot may be required to confirm the diagnosis made clinically.

The initial treatment for clubfoot is the use of non-surgical methods, preferably begun in the first week of life. Serial manipulation and casting using the Ponseti method, taping, physical therapy and splinting, and continuous passive motion with a machine comprise the non-surgical treatment modalities. Most of the cases can be corrected in 6-8 weeks with proper manipulation and plaster casts.

Surgical correction is required in severe cases that do not respond to stretching and may include release of soft tissue and joint contractures, tendon lengthening, and fixation of temporary pins in the foot.