CHILDREN'S HEALTH Birth Defects • Down syndrome • Fetal alcohol syndrome • Phenylketonuria • Ambiguous genitalia • Rett syndrome • Cleft lip and cleft palate • Familial Mediterranean fever • Clubfoot

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Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which a baby's foot is twisted out of shape or position. The term "clubfoot" refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. Clubfoot is one of the most common birth defects and is usually an isolated problem for an otherwise healthy newborn.

Clubfoot can be mild or severe, affecting one or both feet. Clubfoot won't hinder your child's development drastically until it's time for your child to walk. At that stage, the awkward positioning of the foot may force your child to walk on the outside edge of his or her feet, causing an odd-looking stride, stiffness and weakened calf muscles.

Treatment for clubfoot usually begins soon after birth and includes gently stretching the foot into a correct position and placing it in a series of casts. More severe cases of clubfoot may require surgery.

In most cases, clubfoot twists the front of the foot downward and inward, increasing the arch and turning the heel inward. The foot may be turned so severely that it actually looks as if it's upside-down. Also, the calf muscles in the affected leg are usually underdeveloped, and the affected foot may be up to 1 centimeter shorter than the other foot. Despite its look, clubfoot isn't painful.

The cause of clubfoot isn't known (idiopathic). But scientists do know that clubfoot isn't caused by the position of the fetus in the uterus. In some cases, clubfoot can be associated with other congenital abnormalities of the skeleton, such as spina bifida, a serious birth defect that occurs when the tissue surrounding the developing spinal cord of a fetus doesn't close properly.

Approximately one to three of every 1,000 newborns have clubfoot. Almost half of all these cases affect both feet. Risk factors include:

• Sex. Clubfoot is twice as likely to affect males as females.
• Family history. If you, your spouse or your other children have had clubfoot, your baby is more likely to have it as well.
• Ethnicity. Some ethnic groups have a higher likelihood of the defect than others. People of Polynesian descent are most at risk, and those of Asian descent are least at risk.

More than likely your doctor will notice clubfoot soon after the birth of your child. Your doctor can then advise you on the most appropriate treatment.

Most commonly, a doctor recognizes clubfoot after birth just from looking at the shape and positioning of the newborn's feet. The doctor may request X-rays to get specifics as to the severity of the deformity.

It's possible to clearly see some cases of clubfoot before birth during a baby's ultrasound examination. If clubfoot affects both feet, it's more likely to be apparent in an ultrasound. While nothing can be done before birth to solve the problem, knowing about the defect may give you time to learn more about the problem and get in touch with appropriate health experts, such as a genetic counselor and an orthopedic surgeon.

Clubfoot typically causes no problems until your child starts to stand and walk. While your child's mobility may be slightly limited and the affected foot may up to 1 1/2 shoe sizes smaller than the unaffected foot, treating clubfoot generally ends with your child having a relatively normal foot, both in the way it looks and its function.

Left untreated, however, clubfoot can become a burden. Not only is your child likely to experience arthritis, but the unusual appearance of the foot may make body image a concern during the teen years. The twist of the ankle may not allow your child to walk on the soles of the feet. To compensate, he or she may walk on the balls of the feet, the outside of the feet or even the top of the feet in severe cases. These adjustments may inhibit natural growth of the calf muscles, cause large sores or calluses on the feet, and result in an awkward gait.

Because your newborn's bones and joints are extremely flexible, treatment for clubfoot usually begins soon after birth. The goal of treatment is to restore the look and function of the foot before your child learns to walk, in hopes of preventing long-term disabilities. Treatment options include:

• Stretching and casting (Ponseti method). This entails manipulating the foot into a correct position and casting it to maintain that position. Repositioning and recasting occurs every few weeks for three to six months. After the shape of the foot is realigned, it's maintained through stretching exercises, special shoes or splinting at night for up to two years. For this method to work effectively, you'll need to apply your child's braces according to your doctor's specifications so that the foot doesn't return to its original position.
• Surgery. Some severe cases of clubfoot may require surgery, generally when the infant is 9 to 12 months of age. An orthopedic surgeon can lengthen tendons to help ease the foot into a more appropriate position. After surgery, your child will need to wear a brace for a year or so to prevent recurrence of the deformities.

Even with treatment, the defect may not be totally correctable, but treatment usually improves the appearance and function of the foot. In most cases, treatment is successful when clubfoot is an isolated deformity.

Because the cause of clubfoot is unknown, you can't take absolute measures to prevent it. However, if you're pregnant, you can take steps to limit your risk of clubfoot and other birth defects — don't smoke (or be around smoky environments), consume alcohol or use drugs not approved by your doctor.