CLUB foot or congenital talipes equinovarus is a congenital deformity that involves one or both feet. Note though, most babies will have both feet affected.

The foot appears to have been rotated internally at the ankle. This is due to shortened tendons. In some cases, the foot may be turned inwards so severely that it looks like it is upside down. The calf muscles are usually underdeveloped in the affected limb.

Club foot is a relatively common birth defect that occurs in about one in every 1,000 babies and mainly in males. Despite its strange appearance, the child is not in any pain or discomfort, but as they get older, if left untreated, it can lead to walking difficulties.

The cause of club foot is idiopathic (unknown), but it’s thought that it is due to a combination of genetics and the environment within the womb. If a parent has one child with the deformity, the risk of having a second child with the condition is one in 35.

Smoking when pregnant is thought to be a risk factor, as well as using recreational drugs or getting a severe infection during this period. In a small number of cases, club foot occurs as part of a more serious underlying condition that is affecting the baby’s development, such as spina bifida. If left untreated, most children will develop arthritis, calluses, poor gait, and a poor self-image (especially in the teenage years).

Diagnosis

Club foot is usually recognised at birth by the obstetrician or midwife by clinical observation. Occasionally, X-rays may be requested to see the severity of the deformity.

Treatment

Ideally, treatment should begin within the first two weeks of life.

The Ponseti method is the main technique used today. This involves the baby’s foot being gently manipulated into the correct position using casts for about eight weeks. Once completed, it is likely that they will need a minor surgical procedure to lengthen the Achilles tendon.

The child is required to wear special footwear to prevent the foot from clubbing again. These should be worn full-time for the first three months and then at night only up to the age of five.

The vast majority of children using the Ponseti method will have pain-free, normal-looking feet that function well. Some may be left with a slightly shorter leg and a smaller foot when only one limb has been affected.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293- 7119), Mandeville (962-2100), Ocho Rios (974- 6339), Kingston (978-8392), and Savanna-la- Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.