Clubfoot in Newborns: Congenital Pes Equinovarus, Diagnosis, and Treatment

The causes of congenital clubfoot are not clear. It can be either congenital or acquired later in life. In congenital clubfoot, certain muscle groups do not develop fully during pregnancy.

In the case of an acquired clubfoot, however,

• injuries,
• neurological disorders, and
• degeneration of nerves or tendons in the lower leg

play a key role.

Trauma to the lower leg can lead to nerve injuries and, consequently, nerve dysfunction. When a nerve is dysfunctional, the muscles innervated by that nerve can no longer be controlled. This results in a loss of function.

Many muscles of the lower leg help stabilize the arch of the foot. Loss of this function and muscle atrophy can lead to foot deformities, including an acquired clubfoot (resulting from the trauma). The complex deformity of clubfoot consists of several individual deformities affecting the various joints of the foot.

Sickle foot

Sickle foot is considered the most common foot deformity in infants. In this condition, the toes in the forefoot deviate inward.

This condition affects not only the midfoot but also the toes. This deformity can either resolve on its own or be corrected with appropriate therapies.

Pointed foot

A pointed foot is a condition in which the affected person cannot fully plant their heel on the ground. They essentially walk on their tiptoes, which is how this foot deformity gets its name.

Children and elderly people who are bedridden are among the groups most commonly affected by pes equinus. The deformity known as pes equinus, which occurs in conjunction with clubfoot, is usually caused by a shortening of the Achilles tendon. The Latin term for this is *pes equinus*. This name originates from the fact that horses, too, walk only on their toes.

High-arched foot

A high-arched foot is essentially the opposite of a flat foot. The arch is significantly higher, and the foot appears compressed overall. As a result, it appears smaller than it would in its normal physiological position.

In addition to these deformities, the soles of the feet rotate inward, a condition known as supination. Because of this position, those affected walk on the outer edge of their feet.

In cases of congenital clubfoot, treatment should begin immediately after birth, if possible. The earlier treatment begins, the more likely it is that the foot will assume a normal position once treatment is complete.

If treatment is not started immediately, permanent deformities may develop that can only be corrected through surgery.

When selecting the appropriate treatment method, a distinction is made between congenital and acquired clubfoot.

Congenital clubfoot

In cases of congenital clubfoot, surgery is not necessarily indicated immediately. The reason: The tissue of newborns and infants is still quite flexible and can be treated in other ways.

For example, there is the option of using a cast. In this method, the foot is manually corrected on the day of birth and cast in this corrected position. Manual correction is also known as redressment therapy. The goal is to return the feet to their correct position.

Generally, this method does not cause pain for the babies. The cast is changed at increasingly longer intervals, gradually correcting the deformity. To support this, the joints are mobilized through professional physical therapy and rehabilitation exercises. When redressment therapy is performed correctly and the cast is applied properly, conservative treatment is often promising.

To ensure success, however, a night splint or special shoes must be worn even after the cast is removed.

If conservative therapy does not produce the desired results, surgery is indicated. In such cases, the Achilles tendon is often lengthened to correct the pes cavus deformity.

In addition, foot surgery may also involve corrections to the bones or ligaments.

Acquired Clubfoot

In the case of an acquired clubfoot, however, conservative treatment methods rarely lead to the desired result. In some cases, splints or special shoes may help—for example, when the clubfoot is caused by nerve issues.

However, the decision on whether surgery is indicated depends not least on how advanced the clubfoot already is. The more severe the condition, the sooner surgery should be performed.

Surgery alone is not enough in these cases, however. Patients often also require long-term immobilization using a plaster cast to stabilize the surgically corrected position. As part of professional physical therapy, intensive work is done on the muscles.

Postural corrections are also employed so that the clubfoot can be effectively treated.

If a clubfoot is treated in a timely manner and, if necessary, surgically corrected, there is a good chance—especially in infants—of eliminating these deformities.

However, the longer treatment is delayed—or if no treatment is provided at all—the worse the patient’s symptoms will become.