Club foot is a congenital foot deformity where the feet are turned inward and downward at birth. It is not uncommon, occurring in 1 in 1000 births world wide according to the medical literature. Most children with club foot are diagnosed at or near delivery in the US and other developed countries. Therefore, they can be treated earlier, improving outcomes. In the developing world, diagnosis may be delayed for years, and even if diagnosed, treatment may not be available. Untreated club foot can result in a crippling condition, making walking difficult. Fortunately, early diagnosis and treatment can result in restoration of alignment and function in the majority of cases. The cornerstone in treatment of club foot is serial manipulation and casting. With this treatment, the foot is gently manipulated by a skilled practitioner to reduce the the components of the deformity. Manipulation is immediately followed by the application of a well molded plaster cast that extends above the knee. This process is repeated weekly until the desired correction is achieved. Bracing can then be used to maintain the correction until the child begins to walk. The process can take 3-6 months to complete, depending on the degree of and the rigidity of the deformity. Patients that do not respond to this treatment or that have incomplete correction may need surgical intervention. A corrected club foot is never truly a “normal” foot, with many patients requiring further management with orthoses, bracing, shoe modifications and additional surgical procedures in the future. Despites this, most children with corrected clubfoot function well and can participate in physical activities and sports. Untreated clubfoot is rare in the US. We do see them occasionally in people that move here from developing countries. Untreated club foot in adults is invariably treated surgically to be able to align the foot properly for walking. Surgery often involves fusion of several foot joints due to joint abnormalities and arthritis from long term malalignment.
What is it and how do we manage it?
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