Club foot is a deformity of the foot and ankle that is present at birth (congenital).

In a baby born with club foot, the foot points down and inwards with deep inner and heel creases. In cases where both feet are affected, the soles of the feet face each other. Both feet are affected in around half of all cases of club foot.

What causes club foot?

Club foot occurs when the muscles on the outer side of the leg are weaker than those on the inside of the leg. The tendons on the inside of the leg also become shorter than normal.

Tendons are the tough cords that connect muscles to bones. In club foot, the bones of the foot are abnormally shaped and the Achilles tendon (the large tendon at the back of the heel) is tight.

In most cases the cause of club foot is unknown, but it occasionally runs in the family. If you have had a child with club foot, you are 20 times more likely to have another child with the condition.

Read more about the causes of club foot.

The Ponseti method

A baby with club foot will not usually experience any pain and treatment is often effective in correcting the abnormal position of their feet.

Ideally, treatment for club foot will start within a week or two of the baby being born. A treatment technique known as the Ponseti method is the main treatment for club foot, which involves your baby's foot being gently manipulated into position and put in a cast.

This is repeated several times over a number of weeks (the average time is five weeks). After this, your baby will need to wear special boots that are attached to a bar until they are about four years of age.

Although it is sometimes a difficult process to go through, the Ponseti method is effective in treating around 85% of babies with club foot. It is important to stick to the treatment to prevent club foot re-occurring.

Your child’s condition will be regularly reviewed in case they have a relapse and require further treatment. However, provided that the condition is treated early, there should be few long-term side effects.

If club foot is treated when a baby is very young, the position and function of the foot is usually corrected and the child will not experience any painful symptoms. However, in some cases of club foot, long-term pain can occur despite continued treatment and corrective surgery.

Read more about treating club foot. 

How common is club foot?

Club foot affects one baby in every 1,000 born in the UK. It is one of the most common abnormalities that is present at birth, and it is twice as common in boys than in girls.

The cause of club foot is mostly unknown.

Occasionally, club foot is inherited (i.e. it runs in the family). If one parent has club foot, there is a 3%-4% chance that their child will also have the condition. If both parents have the condition, there is a 30% chance that their child will also be affected.

Club foot can often be diagnosed before a baby is born. However, sometimes it is discovered at birth during the physical examination of the baby.

Unborn babies

Club foot can be detected in an unborn baby using an ultrasound scan. However, it cannot be treated before birth.

If club foot is detected in the womb, you may have further tests to determine whether your baby has any other problems, such as restricted growth (see below).

An ultrasound scan is a fairly accurate method of diagnosing club foot, but it is not 100% reliable. Therefore, if club foot is suspected, you will be told about the condition and the type of treatment that will be needed. Your child may be referred to a specialist in treating conditions that affect the bones, such as an orthopaedic surgeon.

At birth

Your newborn baby will usually be given a physical examination within 24 hours of being born. This will include examining the baby’s feet and legs. Club foot will usually be immediately visible.

If your baby has club foot they will be referred to an orthopaedic surgeon immediately. This is because treatment ideally needs to be started within a week or two of birth.

Other conditions

If club foot is diagnosed, your baby may also be checked for other, associated conditions such as:

• spina bifida – a series of birth defects that affect the development of the spine and the brain 
• muscular dystrophy – an inherited condition that gradually causes the muscles to weaken and is therefore not necessarily seen at birth
• conditions that cause short stature, stiff joints and collagen defects. Collagen is a protein that supports tissue and gives it strength

If your baby has club foot, treatment will usually begin within a week or two of their birth. The aim of treatment is to give your baby pain-free and functional feet.

A technique called the Ponseti method (named after Dr Ponseti who developed it) is the main treatment for club foot. An increasing number of orthopaedic specialists (bone specialists) use the Ponseti method and it is available in many clinics. However, not all hospitals provide the service.

The Ponseti method is successful in treating more than 8 out of 10 cases of club foot. Long-term results are also very promising compared to previous surgical treatment methods.

One long-term study followed up people with club foot who had been treated with the Ponseti method 30 years ago. Over three-quarters of the people who were treated either had good or excellent function in their feet. This was only slightly less than a group of people of similar ages who were questioned about pain in their feet and had never had club foot.

The Ponseti method

The Ponseti method involves weekly sessions with a specialist, or another trained healthcare professional, who will manipulate your baby's foot with their hands, gradually correcting the bend in their foot. They will then apply a plaster cast from your baby's toes to their thigh to hold the foot in its new position.

The casts will be changed weekly at each session and your baby's foot will be corrected a little more each time. On average, five or six casts are usually used, but your baby may need to have a few more or a few less, depending on the severity of the condition. 

Your baby's foot will be manipulated gently, so the procedure should not hurt them. Babies will often cry during manipulation and casting although it is not usually due to pain.

Achilles tendon surgery

Following the Ponseti method, your specialist will decide whether your baby needs to have a small operation to release the tight tendon at the back of their heel (the Achilles tendon). This is a very minor operation that most babies with club foot will need to have.

Achilles tendon surgery is often recommended after the front of the foot has been corrected (usually after the fourth or fifth cast) but when the ankle cannot be fully corrected.

The procedure is usually carried out under a local anaesthetic on an outpatient basis, which means that your baby will not have to stay in hospital over night. In some cases, a general anaesthetic may be used so that your baby will be unconscious during the operation.

During the procedure, the surgeon will make a small cut in your baby’s heelcord to release their foot into a more natural position. Your baby’s foot and leg will be put in a plaster cast for about three weeks.

A small number of children will require further surgery when they are between two and seven years of age. This may involve moving a tendon in front of the ankle to a different position to improve the foot’s function.

Boots and bar

After your baby’s foot has been fully corrected they will need to wear special boots that are attached to a bar (brace). This will hold their feet in the most effective position. The boots have straps to attach them firmly to your child’s feet and the bar will keep their feet about shoulder distance apart.

The boots will need to be worn 23 hours a day for three months, and then after this time just at night and nap times until your child is about four years of age.

It is very important that your child wears the boots for the required amount of time otherwise their foot may return to how it was previously and treatment may have to begin again.

Relapse   

Sometimes, club foot can reoccur. This is known as a relapse and it is estimated to occur in 1-2 out of every 10 cases. Relapses are more likely if the treatment method described above is not followed exactly.

If club foot reoccurs, your child may need to repeat some of the treatment stages – for example, they may need to have their foot manipulated again and put in a cast.

In some cases, ensuring that your child continues to wear the boots and bar may be enough to correct their club foot. However, in other cases where there has been a relapse, surgery may be required.