Discovering that your child has clubfoot/talipes can be overwhelming.
Our goal is to offer guidance to help you and your child through their clubfoot journey and provide support along the way.
On this page you will find:
What is Clubfoot/Talipes?
Why Does it Happen?
How is Clubfoot/Talipes Detected?
Treatment of Clubfoot/Talipes
Caring for a Child with Clubfoot/Talipes
How Will Clubfoot/Talipes Affect My Child?
Relapse
Sharing the News
Support
Resources
What is Clubfoot/Talipes?
According to the NHS, clubfoot affects 1-2 in every 1000 babies born in the UK and is more common in boys than in girls. In around 50% of the cases, both feet are affected.
Global Clubfoot Initiative describes clubfoot as “… a congenital condition (present from birth) where a baby is born with one, or both, feet twisted inward and downward.”
Whilst the condition is commonly referred to as clubfoot (or talipes), the medical name is congenital talipes equinovarus (CTEV). Although sounding complicated, when broken up, it becomes easier to understand.
Congenital – Present at birth
Talipes – the foot and ankle
Equino – foot pointing down
Varus – heel turning inwards
Clubfoot, as a condition, should not be confused with positional talipes because this is not a structural clubfoot, but is instead a common temporary presentation of the foot in newborn babies. To read more about positional talipes please read our factsheet
Clubfoot can be classified into a number of different categories with the most common being:
Idiopathic clubfoot
Atypical clubfoot
Syndromic clubfoot
For more information on clubfoot, watch our webinar ‘An introduction to the different types of Clubfoot’
Why Does it Happen?
There is no single known cause of clubfoot, but it occasionally runs in the family. Having a child with clubfoot means you have a 4% chance of your next child being born with the condition.
Clubfoot is believed to result from a combination of genetic and environmental factors affecting how the foot/feet develop during early pregnancy.
How is Clubfoot/Talipes Detected?
Clubfoot can be detected during routine pregnancy scans, although it is not possible to determine the severity or category of the condition at this stage. If not picked up during pregnancy, clubfoot will be detected at birth through a physical examination performed on all newborns.
Treatment of Clubfoot/Talipes
The gold-standard treatment for clubfoot is known as the Ponseti method and is minimally invasive (meaning there is no major surgery).
The Ponseti method involves three stages:
Casting and manipulation
Treatment involves weekly sessions in which a specialist moves the foot with their hands, gradually correcting the position. A plaster cast is then applied from toes to groin to hold the foot in its new position. Casts are changed weekly, with further correction of the foot position at each appointment.
Tenotomy
A minor operation, usually performed under local anaesthetic (so no hospital stay required), whereby the surgeon will make a small cut in your baby’s heel cord to release their foot into a more natural position. Following the procedure, the foot and leg will be put in a plaster cast to ensure the tendon heals in the correct position.
Boots and bar
When the foot position has been corrected, the child wears special boots attached to a bar (brace) to hold the feet in position. The boots are worn for 23 hours a day for the first 3 months, and then just at night and nap times until the age of 5years. Regular footwear may then be worn at all other times.
The boots and bar stage is needed to reduce the risk of a relapse or recurrence of clubfoot so it is really important that this stage is completed as instructed.
Watch the following video, Steps – Clubfoot (Tusko) which takes you through the Ponseti treatment, so you know what to expect.
Caring for a Child with Clubfoot/Talipes
Steps have produced a downloadable booklet – Clubfoot, a Parent’s Guide, which includes more information about clubfoot, its treatment and caring for your child.
When your child is in a cast you should:
Check your child’s toes to make sure they look normal and feel warm
Make sure the toes are always exposed and clearly visible
Change your child’s nappy frequently and fasten it as normal, to avoid soiling the plaster
Check the skin around the edge of the cast for any signs of redness or soreness
Keep the plaster cast dry at all times
It also helps to:
Use clothing which does not cover the feet
Use cushions to help your baby sit comfortably
Look out for signs the cast is rubbing
Contact the hospital immediately if:
You cannot see your child’s toes (indicating the plaster may have slipped and so will not be correcting the feet properly)
Your child’s toes change in appearance or become cold
The plaster becomes loose, cracked or crumbly
The boots and bar stage is often the most challenging part of the treatment for parents but it is vital for the long-term success. Each child will react differently to the boots and bar, but they are unlikley to be in any pain. Whilst your child will be unable to move their legs independently, they will be able to kick and swing their legs simultaneously. Do not be afraid to play with you child.
Top tips:
Padding the bar will help to protect your child, yourself and your furniture
Baby sleeping bags will help with padding and keep your baby from pulling at the straps and laces
Breast or bottle feeding should still be easy but ask your midwife or health visitor for guidance if unsure
Most parents find they do not need to buy special equipment for either the casting or boots and bar stage but Steps have created a Ponseti Equipment list, based on suggestions from parents, for the equipment, such as car seats and buggies, that they found most helpful through Ponseti treatment.
How Will Clubfoot/Talipes Affect My Child?
Most children do very well with treatment and there will be no problems going to school and taking part in a full range of sporting activities. Nevertheless, your specialist will probably monitor your child until their feet have stopped growing.
One long term (30+ years) study following children through to adulthood specifically looked at the results of the Ponseti method. This study showed that the use of this method resulted in no greater severity of foot pain in adulthood to those experienced by people not affected by clubfoot.
Relapse
If you think there is a relapse, it is important to have an assessment with a specialist clinician. The Steps – Clubfoot, a Parent’s Guide provides information on the signs, diagnosis and treatment of relapsed clubfoot.
In the meantime, exercising and stretching is really important to keep all the muscle groups strong; particularly those around the foot, to ensure the foot is kept as supple and mobile as possible.
A physiotherapist should provide you with suitable stretches, especially calf stretches, and simple exercises to do at home which may include hopping, walking on heels, balancing on one leg and the use of resistance bands (to help the muscles on the outside of the foot).
Our Strong and Stretchy Feet video below provides a helpful work along guide, however, please speak to your clinician before undertaking any exercises and stretches if this information has not already been provided to you.
Work on strengthening the core and leg muscles and keeping a good general fitness is also recommended, but in a low impact way. Cycling, swimming and yoga, when possible, are all low impact activities the whole family can enjoy together.
Sharing the News
When and how you tell close family, friends and other relatives about your child’s condition is a very personal decision which will be impacted by how and when the diagnosis occurred, the individual prognosis for your child and the potential treatments available.
There is no right or wrong way or time to share the news, however, being well informed about the condition and having the opportunity to connect with other parents who can understand what you are feeling will likely help.
Once you do share the news, your relatives and friends will probably want to know how they can support you and your child, so take advantage of the experiences being shared by other parents, to help you feel better equipped to answer such questions and get the support that is right for you.
Support
Steps is here to offer emotional and practical support.
The Steps closed Facebook Group is a friendly and safe way of discussing your worries, sharing tips and finding emotional support. Our Family Contact Service identifies someone else who has been through a similar situation and who’s happy to talk about their experiences, on a one-to-one basis, to offer support.
You can reach out to Steps with your questions, concerns and requests via email info@steps-charity.org.uk or leave a voicemail message on 01925 750271 and one of the team will be in touch.
All our clubfoot links and related resources can be found below
