What to do if your baby is found to have Clubfoot when you are pregnant?

Clubfoot as the name itself suggests refers to foot abnormalities in a child. These abnormalities are congenital in nature which means they are present at birth. So why exactly does this problem occur?

Clubfoot happens when the tendons are shorter than usual which means the connecting tissues between the muscle and the bone are short. It is a fairly common birth defect and is usually an isolated problem for an otherwise healthy newborn. About 1 out of 1000 babies born everyday has a twisted ankle

Symptoms:

• The toes are curling inwards while the foot is pointing downwards.
• The foot is going in the other direction (sideways)
• One foot might be smaller than the other.
• The foot may have a limited range of motion.

Limb formation in the Utero:

In order to understand clubfoot it is important to know more about fetal development. During the first trimester especially between weeks 5-6 your baby develops two buds that eventually lengthen and grow into arms. The same thing happens during week 7 when two additional buds sprout up that become your baby’s legs after sometime. It was established during anatomic studies related to the growth of the embryo that during the development of the lower limb, several changes in the foot position take place that can be observed as a temporary physiological clubfoot.

Types of Clubfoot:

Clubfoot deformity can be divided into three types

• Idiopathic Clubfoot (talipesequinovarus) the most common occurring kind
• Neurogenic Clubfoot (caused due to underlying neurological conditions)
• Syndromic Clubfoot (caused to some underlying syndrome such as arthogryprosis)

Ultrasound Diagnosis:

While a clubfoot can be diagnosed during an ultrasound it is pertinent to mention that a diagnosis solely based on an ultrasound has a chance of producing a false positive. In most of the cases it is easier to diagnose for a clubfoot as the time for delivery comes closer, for instance; it is easier to spot a clubfoot at 24 weeks as compared to 13 weeks. About 80 percent of cases related to clubfoot can be predicted after the first 24 weeks.

Causes:

The exact reasons as to why clubfoot happens to babies is idiopathic (unknown to the doctors) however, there are a lot of risk factors that are often looked upon when it happens:

• Gender: male babies are more likely to develop clubfoot inside to womb as compared to female babies. 2/3 of the babies with clubfoot are male.
• Family History: Babies who have someone in their close relations such as parents or siblings with clubfoot are more likely to develop it.
• Wrong Lifestyle Choices: women who drink or do drugs during their pregnancy also hamper the growth of their child which in turn can cause clubfoot
• Lack of amniotic fluid: amniotic fluid is a liquid that surrounds the womb while a woman is pregnant and research has showed how the lack of the same can cause a higher chance of your baby being born with a clubfoot.

How it affects the baby:

 Most of the babies born with clubfoot are healthy and as good as half of them have it in both the legs (clubfeet). While this condition isn’t painful in a lot of cases, depending on the severity it can hamper your baby’s ability to walk which is why doctors recommend treating it as soon as possible post the birth.

Antenatal Consultation with Paediatric Orthopaedic Surgeon:

While there is nothing a doctor can do before the birth of the baby, it is important to get into touch with a paediatric orthopaedic surgeon to understand better about your baby’s condition and consider what exact method would the doctor recommend to treat the child whenever he/she is born. Your surgeon would also help you plan everything better so that you are mentally prepared for the whole thing.

Treatment:

Antenatal Treatment: as mentioned earlier nothing can be done to fix a clubfoot while the baby is in the womb, it is important to consult your paediatric orthopaedic surgeon to sketch out a plan for the treatment. You can also consult a gene counsellor to understand the same.

Postnatal Treatment: babies tend to have very soft and flexible tendons which is why the aim is to start the treatment as soon as possible (preferably during the first or the second week after birth). The goal is to start the treatment before they start learning how to walk/crawl. The treatment usually offered by doctors can be bifurcated into two:

• Ponseti method
• Surgery

Ponseti method- also known as the stretching and casting method includes

• Moving the baby’s foot into the correct position and the securing it with a cast
• Reposition and recasting the same once a week for several months
• Performing a minor surgery to lengthen the tendons at the end of the procedure

Once the baby’s foot is realigned you’ll have to continue with either or all of the following to ensure that the foot doesn’t go back to its original position.

• Doing stretching exercises with your baby
• Putting your child in special shoes and braces
• Making sure your child wears the shoes and braces as long as needed — usually full time for three months, and then at night and during naps for up to three years.

Surgery:

In cases where the clubfoot is severe and cannot be simply cured with non-surgical, a more invasive surgery is often performed by the doctor to lengthen the tendon and to reposition the ligaments. Once this surgery is performed your child would be in a cast for two months and would have to continue wearing braces at least for a year to prevent the clubfoot from coming back.

When to worry:

While a clubfoot can be easily cured and isn’t something bothersome, it is important to start the treatment as soon as possible to avoid any complications in the future. A clubfoot if not treated can lead to

• Arthritis: your child will be prone to developing arthritis.
• Inability to walk normally- the twist in the ankle may prevent your child from walking on the sole of the foot which will make him dependent on ball of the foot in order to compensate; making the walk difficult and awkward.
• Poor self-image- last but not the least, it can lead to a poor self-image especially during the early stages of your child where they might feel insecure and ashamed for being different.

With this we hope you were able to garner all the information you were looking for in regard to clubfoot. Don’t forget to check out our other articles!