Sickle Foot and Pes Adductus: Common Congenital Foot Deformities (Sickle Foot) of the Forefoot and Foot

In cases of clubfoot, the foot takes on the shape of a sickle. The forefoot turns inward, and the toes are severely bent inward. Doctors refer to this as an “adduction position” (adduction means drawing toward the body). Often, the metatarsophalangeal joint of the big toe is also bent inward.

This deformity usually occurs in both feet but is generally painless. With a few exceptions, affected children can move around completely normally. However, it is not uncommon for toddlers with a clubfoot to have difficulty learning to walk because they turn their feet and legs sharply inward. This may lead to orthopedic problems.

The cause of this foot deformity originates during pregnancy. However, in most cases, it resolves on its own. If this is not the case, there are various promising treatment options available.

Sickle foot usually develops in babies while they are still in the womb. One of the main causes is a lack of space. The uterus is cramped and space is limited—in some cases, this forces the unborn baby into an awkward position. This can sometimes cause the foot to bend inward.

This explains why many children already exhibit this foot deformity at birth. For this reason, premature babies are very rarely affected by clubfoot: they leave the womb before such a lack of space develops.

Other causes of clubfoot include:

• genetic factors (if both parents carry the genetic traits for it)
• the infant frequently lies on their stomach
• shortened muscles on the inner side of the foot

If babies or toddlers frequently lie on their stomachs, their feet are forced into an unfavorable splayed position. The toes rest on the floor, causing the forefoot to bend inward. In some cases, this can result in clubfoot after birth; however, this is very rare and the exception rather than the rule.

Usually, the foot deformity resolves on its own during early development. If this does not happen and the clubfoot is not treated, further consequences are possible.

In addition to problems with learning to walk or an altered gait, the following effects may sometimes occur:

• stiffening of the midfoot due to the deformity
• incorrect weight-bearing leads to pressure points (for example, on the knee joint)
• Premature cartilage degeneration and bone damage (osteoarthritis) are possible
• especially in adults: pain when walking, pressure points

The diagnosis of a clubfoot in toddlers is generally made during a routine medical examination. In babies, pediatricians often notice the foot deformity during routine well-child checkups. Typical symptoms, such as a collapsed midfoot and a bent big toe, are usually sufficient for a visual diagnosis.

In toddlers, the characteristic gait—with feet and legs turned inward—provides a clear indication of a clubfoot. If a clubfoot is suspected, doctors can also determine the exact extent of the condition using an X-ray.

Orthopedists also test whether the clubfoot can be passively corrected. To do this, they hold the foot firmly at the back and slowly move it into the normal position. This test provides important information and guidance on the best possible course of further treatment.

In many cases, clubfoot resolves on its own over time. Therefore, comprehensive treatment is not necessary for about 80–90% of patients. Nevertheless, parents should keep a few tips in mind to support their children:

• Manual correction: Use your hands to repeatedly guide the foot back into its normal position
• Gently stroke the edge of the foot with your finger—this often causes the foot to return to its physiological (i.e., normal) position on its own
• Foot massages, for example, regularly while changing diapers
• If the feet are warm, gently stimulate them with ice cubes
• Do not place babies on their stomachs for too long or too often
• When the baby is lying on their stomach, place foam rings around their legs

Foam rings are simply placed around the thighs when the baby is lying on their stomach. On the one hand, this is a way to support the healing of clubfoot. But it is also a preventive measure: parents use it to prevent clubfoot from developing in healthy babies in the first place.

In most cases, mild deformities correct themselves over time. If this is not the case, or if the deformity is very pronounced, various treatment methods and options may be considered. A distinction is made between 

• conservative (non-surgical) and 
• surgical procedures

What conservative treatment methods are available?

When selecting a treatment method, the most important factor is whether the child is already walking or is still in the crawling stage. 

• In infancy and for babies who cannot yet walk, corrective casts are applied to the thighs for several weeks.
• Afterward, the babies are fitted with so-called positioning shells, which correct the foot only at night.
• Toddlers who are already walking are given supportive insoles for their shoes. These provide heel support and feature a raised inner edge that corrects the misalignment.
• Physical therapy is also beneficial. It stabilizes the foot and strengthens the muscles.

What surgical treatment options are available?

Surgery is recommended only very rarely. Doctors try to avoid this option, especially for babies. However, if other treatment measures prove ineffective, surgery is a reliable treatment method. 

• One option is to sever the tendon attachment in the big toe. 
• Another option is to remove joint capsules throughout the foot to make it easier to align the foot correctly.
• The foot is then stabilized with wires.

In adults, the treatment is usually somewhat different. In these cases, bone segments are typically removed during surgery. This makes it possible to adjust the position of the foot and achieve normal alignment.

With a little help, a clubfoot often corrects itself. Clubfeet can occur in both children and adults—though the deformity usually corrects itself during early development. 

Parents have many ways to support this self-correction: 

• Foot massages
• targeted stimulation, and 
• spending more time lying on the back or side are important tips to follow.

If the deformity does not correct itself, various treatment approaches can be considered. From physical therapy to medical devices to surgery, there are many effective options. It is important to take advantage of these: If a clubfoot remains untreated for a long period of time, it usually leads to further damage.