Prenatal Diagnosis FAQ

Clubfoot is a term used to describe a range of unusual positions of the foot. C.A.V.E. is the acronym used to assess major physical findings:

• Cavus in the midfoot – high arch
• Adductus of the forefoot – foot turned in from the midpoint
• Varus of the hindfoot – foot rolled inwards
• Equinus of the hindfoot – foot pointed downwards
• The clubfoot may also be short and fat
• The calf muscle may be thinner on the affected leg

Most types of clubfoot are present at birth (congenital clubfoot). Clubfoot can happen in one foot or both feet. In almost half of affected infants, both feet are involved (bilateral clubfoot). Although clubfoot is painless in a baby, treatment should begin immediately. Clubfoot can cause significant problems as the child grows. With early treatment most children born with clubfoot are able to lead a normal life.

In some cases, clubfoot is the result of the position of the baby while it is developing in the mother’s womb (postural clubfoot). But more often clubfoot is caused by a combination of genetic and environmental factors that is not well understood. If someone in your family has clubfoot, then it is more likely to occur in your infant. If your family has one child with clubfoot, the chances of a second infant having the condition increases. Because the exact cause of clubfoot is unknown, you cannot prevent it from developing during pregnancy. If you are pregnant, continue to follow safe guidelines to limit your baby’s risk of birth defects.

The Ponseti Method (created by Dr. Ignacio Ponseti in the 1950s) is a non-surgical treatment and is recognized as the best method to treat clubfoot. The Ponseti Method involves a series of casts to stretch and set the foot into position, and braces to hold the positioning of the foot. Invasive surgery can be avoided in many cases.

It’s important to research and ask questions to ensure you understand the Ponseti treatment process. Connect with other families and build a support system of family and friends. Locate a doctor skilled in the Ponseti method of treating clubfoot and be sure to communicate with your medical team throughout your infant’s treatment. Schedule a consultation before your baby is born to meet your doctor and have full understanding of the treatment timeline once your baby is born.

Most children with clubfoot will have no other conditions but sometimes clubfoot can occur with other diagnosis’ such as Spina Bifida. For this reason, as soon as clubfoot is noticed, it is important that the infant be screened for other health conditions. Clubfoot can also be the result of problems that affect the nerve, muscle, and bone systems, such as stroke or brain injury.

Depending on the resources available, you may receive a more detailed ultrasound and see a geneticist and/or neonatologist. You may also be offered genetic testing to rule out possible genetic causes. It is also possible that you will have a consultation with the practitioner who will treat the clubfoot and explain what treatment will look like.

While some children are diagnosed with both clubfoot and hip dysplasia, there does not seem to be strong evidence supporting a link between the two conditions. Routine examination for hip dysplasia should be done at birth, and can be diagnosed with ultrasound.

The following resources are good sources of additional information:

• Ponseti International
• Canadian Clubfoot Support Society
• Canadian Orthopedic Association
• Parents Guide to Clubfoot, Betsy Miller (Amazon.ca)
• Global Clubfoot Initiative. Clubfoot Cares

Clubfoot babies require or enjoy much of the same items as typical babies. Swings, bouncy chairs, and rockers can be soothing for any young child. “Boppy” pillows or loungers can be comfortable for your child when in casts to help elevate their legs. Many children in casts can still be carried in wraps or structured carriers, just check with your healthcare provider. Clothing is the item that requires some alterations due to casts and bracing; you may want to avoid footed PJs and tight-fitting bottoms for the casting stage. Some parents like to use leg warmers over their child’s casts or elastic bottom gowns to sleep in. There are swaddles that can be used with your babies legs as well. One fun item is a casting kit to make a model of your child’s feet prior to casting.

Yes, please see this resource for more information: http://www.ponseti.info/ponseti-doctors-by-location.html

Many support groups exist online. Facebook is used by many parents to connect with other clubfoot families. Other support groups include STEPS (South Africa), the Global Clubfoot Initiative and Miracle Feet.

If correctly treated early in life, the majority of children will have normal looking feet and function for practical purposes. Most treated children grow into fully capable adults with a normal and active life. Poorly manipulated feet may compound the deformity rather than correct it, so ensuring you have the right specialist is a priority.

Relapses in clubfeet do occur but are reduced with proper bracing for a sustained length of time. The relapse rate is 16% at age three for those who have been compliant in proper bracing and continues to reduce with brace wearing until the age of 4 or 5. Most relapses occur when bracing is not consistent or discontinued early.

Children who have undergone treatment for clubfeet can participate in all activities. Many famous athletes had clubfeet as children, including Kristi Yamaguchi, Olympic Gold Medal Figure Skater and Troy Aikman, American Footballer.

Yes, it is possible that clubfoot can be passed down through families, as genetic factors are believed to play a major role but is not fully understood.

There can be a difference in size of leg or feet in unilateral clubfoot, but this is less common in bilateral clubfoot.

Yes, your baby’s casts or BNB should not impede your ability to breastfeed. You may need to adjust positioning to accommodate the casts or BNB, but many parents find continued success in breastfeeding. You can provide support for your baby’s casts by placing a rolled up receiving blanket underneath the cast, if they are nursing in a side position.

No, you did not cause your child to be born with clubfoot, and are not being punished. Patients with clubfoot are born around the world everyday and it is not anyone’s fault. The exact reason it occurs is not known but it can be linked to genetics and environmental factors.

The clubfoot treatment journey is not just about your child but also about you. In order for your child to be successful in treatment, you also need to care for yourself, and a large part of clubfoot treatment is placed on your shoulders. Reach out to friends and family and ask for support, or try to connect with other clubfoot parents who have been on the journey too. It is normal to feel a lot of emotions during treatment, but if you are concerned about your mental health, please seek help from a mental health professional.

The social media support groups for clubfoot parents can be great to gather tips and advice and connect to other parents, but if you are just starting out on the journey, it can be information overload. Limit the time you spend in the groups and focus on the information that you need rather than simply scrolling through the group. Support groups have their place, but it is important to remember that you shouldn’t be requesting medical advice from those unqualified to give it. If you have specific medical questions, like if you are concerned that your child’s feet are not fully corrected, it is important to seek a second opinion from a qualified medical expert rather than a social media group.

If the clubfeet are fully corrected, then it is not considered a disability. If the feet are not fully corrected, leading to further dysfunction of the feet, and decreased mobility and functionality into adulthood, it could be considered a disability.

It can be difficult to try and explain to someone else something that you are still learning about yourself. It can be helpful to compare the treatment process to something that is easily understood by many, such as dental braces. The casting part of clubfoot treatment is like wearing braces on your teeth, the casts get the feet into the correct position, similar to braces on the teeth. The BnB portion of treatment is like wearing a retainer after dental braces, they keep the feet in the correct position. Just like the retainer keeps the teeth in the corrected position. And just like if you don’t wear your retainer, your teeth can move back into their original position, if the child doesn’t wear their BnB, their feet can move back to their original position.

First, let yourself process your emotions about the diagnosis. It can be very overwhelming to hear that your child will be born with a birth defect, so give yourself time and space to feel those emotions. It is okay to feel sad and scared, the clubfoot diagnosis is new for a lot of parents and learning all about treatment is a lot. Once you have allowed yourself time to process the diagnosis, you can start researching the Ponseti Method, the more knowledge you have about the process the more confident you will feel when you need to make decisions about your child’s care. Take comfort in the knowledge that clubfoot is a fixable birth defect and that while the treatment is not a quick fix, it is minimally invasive and very effective.