Clubfoot

Clubfoot (talipes equinovarus) is a condition present at birth in which one or both feet are turned inwards and downwards. The heel looks small, the foot is twisted to the inside, and the calf muscle on the affected side is usually smaller than the other. Clubfoot is not painful for the newborn, but without treatment it makes walking very difficult. With early treatment, children can lead normal active lives.

Clubfoot affects roughly 1-2 in 1,000 births. It's twice as common in boys, and in about half of cases affects both feet. India has one of the largest numbers of children born with clubfoot each year — around 50,000 — and most can be fully corrected with simple, inexpensive treatment if started early.

What causes it?

In most cases the exact cause is unknown ("idiopathic clubfoot"). Risk factors include:

• Family history of clubfoot
• Being male
• Smoking during pregnancy
• Certain conditions that limit foetal movement in the womb

A smaller group of clubfoot cases are associated with other conditions — spina bifida, cerebral palsy, arthrogryposis. These "syndromic" cases can be more complex to treat.

Diagnosis

Often detected on antenatal ultrasound from around 20 weeks. Confirmed at birth by clinical examination — clubfoot has a characteristic appearance that is hard to miss.

Treatment — the Ponseti method

The gold-standard treatment is the Ponseti method — a series of gentle manipulations and plaster casts to gradually correct the foot position. Steps:

• Treatment starts soon after birth (ideally in the first few weeks)
• The foot is gently manipulated and held in place with a plaster cast, changed every week for 5-7 weeks
• A small tendon (Achilles tenotomy) is released in a minor procedure in most cases
• After the cast phase, the child wears corrective boots with a bar (foot abduction brace) — full-time at first, then at night until around age 4-5, to prevent relapse

The Ponseti method has a success rate of over 90% and avoids major surgery for most children. In India, Ponseti programmes are run by many hospitals and NGOs, often at little or no cost — families who start early usually see excellent outcomes.

More complex cases (syndromic clubfoot, older children who missed early treatment, or relapses) may need corrective surgery. Even here, outcomes have improved considerably.

What parents should know

• Early treatment is essential — start in the first weeks of life if possible
• Commitment to the bracing phase (often 4-5 years) is as important as the initial casting — relapses almost always occur when bracing is abandoned early
• Children who complete treatment almost always walk, run, play sports, and go to school normally
• This is treatable. Do not accept "nothing can be done."