What Is Clubfoot (Pes Equinovarus)? How Is It Treated?

Pes equinovarus, also known as clubfoot, is one of the most common congenital orthopedic anomalies. Characterized by one or both feet turning inward, clubfoot is a common orthopedic condition seen in 1 to 2 out of every 1000 live births. Often diagnosed during a routine ultrasound examination later in pregnancy, pes equinovarus may in some cases be noticed right after birth. The causes of clubfoot, risk factors, diagnosis and treatment methods are covered in the rest of this article.

What Is Clubfoot (Pes Equinovarus)?

Under normal circumstances, in a healthy pregnancy, the lower extremities (legs and feet) of the fetus begin to develop in the 4th week of pregnancy. Generally after the 20th week of pregnancy, as the lower extremities reach their proper length, the feet begin to turn outward and reach their natural position by the 28th week. In pes equinovarus, one or both feet are seen turned inward. In clubfoot, a congenital anomaly, the sole of the foot faces sideways or upward while the toes are generally turned inward. If pes equinovarus is not treated early, depending on the degree of the anomaly, it may cause severe walking disorders in later periods.

What Are the Symptoms of Clubfoot?

When clubfoot symptoms are mentioned, the first thing that comes to mind is one or both feet pointing inward, differing from their natural position. This foot deformity, generally noticed during a routine ultrasound examination, has certain characteristic features. The main symptoms can be listed as follows:

A kidney-shaped hollow on the inner side of the foot,

The affected leg or foot being shorter than the other side,

Wrinkle-like appearance on the top or sole of the foot,

The arch from the sole of the foot to the heel being higher than normal,

Weaker muscles in the calf,

Stiffness and restricted movement in the ankle.

In addition to the above, pain is not seen in babies in the early period, but when the baby starts walking and tries to walk by placing weight on the side of the foot, problems such as pain and calluses on the feet may occur. Therefore, it is important that babies diagnosed with pes equinovarus start treatment under the supervision of a physician specialized in the field shortly after birth. If your baby has clubfoot syndrome, do not neglect to seek help from a specialist doctor without losing time.

What Are the Causes of Clubfoot (Pes Equinovarus)?

The cause of clubfoot is not known precisely. For this reason, pes equinovarus is referred to in some sources as idiopathic (of unknown cause) pes equinovarus. In addition, according to some scientific studies investigating the causes of the problem, genetic predisposition, adverse events during pregnancy or environmental factors may cause congenital anomalies in babies. The main causes of pes equinovarus can be listed as follows:

Genetic factors: According to scientific studies, the great majority of pes equinovarus cases are related to genetic factors. In other words, the risk may be higher in babies with a family history of pes equinovarus compared to other babies.

Amniotic fluid (the baby's water) deficiency: Some problems, such as a deficiency of amniotic fluid during pregnancy, can negatively affect fetal development. Some research suggests that a decrease in amniotic fluid in the uterus may exert pressure on the fetus and restrict its movements, and as a result, pes equinovarus deformity may occur.

Muscle anomalies: Muscle problems play an important role in the development of pes equinovarus. Some muscle diseases may lead to deformities in the lower limb and prevent the foot from reaching the correct position.

Vascular anomalies: Some studies show that in individuals with clubfoot, blood flow in the dorsalis pedis artery on top of the foot is low and the pulse is weaker. Insufficient blood flow to the foot may cause pes equinovarus during development.

Muscle and nerve diseases (neuromuscular diseases): According to some scientists, one of the most important causes of clubfoot is neuromuscular diseases that cause imbalance in the muscles.

Environmental factors: Some medications used by the expectant mother during pregnancy may cause congenital clubfoot in babies. In addition, harmful habits of the expectant mother, such as alcohol and cigarette use, may also increase the risk of pes equinovarus in babies.

How Is Clubfoot Diagnosed?

Under normal circumstances, expectant mothers are regularly monitored by a specialist physician during pregnancy. During these checkups, specialist doctors use ultrasonographic imaging methods to check the health of the expectant mother and the fetus. Diagnosis is usually made during a routine ultrasound examination performed after the 20th week of pregnancy. Clubfoot is one of the congenital anomalies that can be easily seen from the outside. In some cases, the specialist physician may notice pes equinovarus in the baby right after birth. A physical examination is usually sufficient to make the diagnosis. However, in some cases, doctors may also use various imaging methods to rule out other health problems.

When babies with clubfoot syndrome are examined, it is seen that a significant proportion of them have pes equinovarus in their families. For this reason, the medical history of the patient and family members is first taken by pediatric specialists. This information can help specialists during the diagnosis and treatment of clubfoot.

Although pes equinovarus belongs to the group of idiopathic (unknown cause) diseases, in some cases it may also appear as an extension of a neurological health problem. For this reason, it is important that babies born with the syndrome first undergo a general physical examination. In order to properly plan the treatment process, doctors may request certain tests to determine whether the baby has another anatomical or neurological health problem. In addition, radiological imaging methods are also frequently used during diagnosis. X-rays are often taken before, during and after treatment to understand the patient's general condition.

What Are the Treatment Methods for Clubfoot?

Clubfoot syndrome is an anomaly that has been seen since ancient Egyptian sources, and it even has a place in Hippocratic-era sources. For this reason, many scientific studies on its treatment have been carried out since ancient times. In the treatment stage, the primary aim is for the patient's foot to have an appearance and function as close to normal as possible without needing casts or supports.

Today, there are two main approaches adopted in the treatment of pes equinovarus, namely conservative and surgical methods. During treatment planning, specialist doctors may, after taking the parents' views into account, prefer to use non-surgical conservative methods first. The main treatment methods can be listed as follows:

Ponseti method: One of the most commonly used methods in the treatment of clubfoot (pes equinovarus) is the Ponseti method. During treatment with the Ponseti method, the baby's foot is first placed in a cast. Over several weeks, the cast is replaced at 4–7 day intervals, and each time the baby's foot is brought gradually closer to the correct position. Before the final cast is placed, the specialist doctor may lengthen the Achilles tendon, which connects the heel to the calf muscles, through a minor surgical procedure to allow the foot to move more freely. During this operation, the doctor makes a small incision in the area of the Achilles tendon with the aid of local anesthesia; since the incision is quite small, stitches are usually not required. After the operation, about 3 weeks are needed for the tendon to heal. During this period, the baby's foot is placed in a cast again. For a positive outcome from the Ponseti method, it is important that the baby performs regular stretching exercises, wears special shoes recommended by the doctor for a certain period, and uses an orthosis (foot support brace).

French method: Although the French method is similar to the Ponseti method, the medical equipment used during treatment is different. While casts are used in the Ponseti method to give the foot the correct position, splints and tapes are used in the French method. Treatment with the French method is administered by physiotherapists. During treatment, the baby's foot must be secured with tapes and splints every day and for at least 2 months. Although this method can be applied by parents at home, it is important that the baby is checked by a physiotherapist every few weeks so that the baby's condition can be monitored. As with the Ponseti method, Achilles tendon surgery may also be needed after the French method. The effect of treatment with the French method usually appears within an average of 3 months. However, to maintain the correct position of the foot, parents may need to repeat the treatment at intervals recommended by the physiotherapist until the child reaches 2–3 years of age.

Clubfoot (pes equinovarus) surgery: Surgery is generally preferred as a final step in the treatment of pes equinovarus. Surgical methods are used when no result is obtained with the Ponseti or French method and/or when the syndrome is severe in the baby. This surgery generally needs to be performed before the baby begins walking. During the operation, the specialist surgeon loosens some of the tendons that connect the muscles to the bones and, after partially correcting the foot, places it in a cast. The feet remain in casts this way for 2 weeks. Then the foot is fully corrected and placed in a cast again. After the baby's foot has remained in a cast this way for 6 weeks, it is checked whether the foot has corrected, and if necessary, casting may be applied again.

It is important to start treatment shortly after birth. Therefore, if your baby has pes equinovarus syndrome, do not neglect to consult a specialist doctor without losing time.

How Long Does Clubfoot Treatment Take?

The duration of treatment may vary depending on the treatment method applied. In cases where methods such as the Ponseti and French methods are used, a visible improvement in the baby's affected foot generally occurs within the first 3 months. In patients who undergo surgery, improvement in the baby's foot may also be observed within approximately 2–3 months. In addition, after the treatments applied, special shoes or an orthosis may need to be worn by the baby until the age of 3–4 years.

Frequently Asked Questions

Clubfoot (pes equinovarus) is one of the most common congenital orthopedic anomalies worldwide. Some of the questions most frequently asked about pes equinovarus are detailed below. In patients with clubfoot, non-surgical treatment options are evaluated first. In most cases, treatment of clubfoot is possible with non-surgical methods such as the Ponseti or French method. Children born with this anomaly have feet turned inward and sideways. It can be easily noticed from the outside. Clubfoot left untreated in the early period may lead to walking problems in later periods and, consequently, to disability. The success rate of surgery, while quite high, also depends on the severity of the foot deformity. After successful treatment, the foot takes a position closest to its normal position, making normal walking possible. Since it is a congenital anomaly, clubfoot does not correct itself with exercise or in any other way. If pes equinovarus is not treated, it may cause serious movement restriction in the future. If you think your child has clubfoot, do not neglect to make an appointment with a specialist doctor and have the necessary checks done as soon as possible.