ONE STEP at a time...

Club foot is the most common musculoskeletal birth deformity, affecting 200 000 babies each year, but many people are not even aware of the condition, what causes it, or how it is treated

There’s nothing more delicate than a tiny pair of newborn feet and nothing more heart warming than the sound of pitter patter when those little feet finally take their first steps. However, thousands of babies across the globe are born with club foot, which can make walking difficult to almost impossible. The good news is that club foot can be treated with a 95 percent success rate.

WHAT IS CLUB FOOT?

Paediatric Orthopedic Surgeon, Dr Mark Eltringham at the Sunninghill Hospital, explains club foot, also known as Talipes Equinovarus, is a developmental abnormality in one or both feet that affects an estimated one in 1 000 babies. “While degrees of the condition vary, most babies with club foot have feet that appear twisted out of shape or position. The foot may be turned so severely that it actually looks as if it’s upside down – the term ‘club foot’ actually refers to the way the foot is positioned at a sharp angle to the ankle, almost like the head of a golf club,” he explains. “In some cases, the calf muscles in the affected leg are usually underdeveloped, and in other cases the affected foot may be up to one centimetre shorter than the other. The condition can be mild or severe, and about half of babies with club foot have it in both feet. While it looks painful, club foot doesn’t cause your baby any discomfort but problems begin to arise when your baby starts walking. Without treatment, a baby born with club foot will eventually start walking on their ankles or on the sides of their feet. Over time, the feet become fixed in this position and walking is difficult. However, with treatment, the vast majority of babies born with clubfoot recover completely during early childhood and are able to do practically anything an otherwise healthy baby can do.”

HOW DOES A BABY GET IT?

Doctor Matthew Gooding, Gynaecologist and Obstetrician at Sandton Medic-Clinic, explains that while in the majority of cases the exact cause of club foot is unknown, the condition may arise because of a developing baby’s position of the feet in certain conditions while in the womb, such as reduced amniotic fluid volume or amniotic bands (where thin strands of tissue form in the uterus). More often though, club foot is caused by chromosomal abnormalities and genetic syndromes. “The condition, which affects more boys than girls, can be detected using ultrasound in pregnant

moms from 13 weeks,” says Dr Gooding. “In situations where the condition is not detected antenatally, club foot is usually diagnosed immediately after birth simply by looking at the foot. In South Africa, it’s difficult to say how many babies are born with the condition (it’s estimated that one in 500 cases occur in Africa). I previously worked in a referral hospital where we saw an increased number of cases, but this gives a distorted impression. A colleague of mine, who has been in private practice for the last 25 years has seen just five cases.”

He goes on to explain at least ten percent of cases are associated with other developmental abnormalities, including spina bifida and other neuromuscular conditions. “The congenital form could result from any abnormality in the bones, tendons, blood vessels or muscles. The severity of the condition is dependent on whether other abnormalities are present. Taking a folic acid supplementation from your first trimester has been shown to decrease the incidence of spina bifida and so indirectly the risk of club foot can be reduced. However, the majority of cases are unavoidable.”

TIME FOR TREATMENT

Major surgery isn’t the go-to option in treating this condition. Karen Moss, mom to a son who was born with bilateral club foot and founder of STEPS, the only NGO in southern Africa focused on the treatment of club foot, explains that 95 percent of club foot cases can successfully be treated with The Ponseti method. “The Ponseti method, devised over 60 years ago by Dr Ignacio Ponseti, avoids cutting the tight ligaments, tendons and joint capsules. It is a carefully constructed sequence of plaster casts and braces for children with club foot,” explains Moss. “Long term follow up studies show superior results to operative techniques. Typically the method takes about six or seven plaster casts, changed weekly. For over 80 percent of cases, the tight Achilles tendon is cut in a minor procedure (tenotomy) and the corrected foot is put in a holding cast for three weeks to allow the tendon to regenerate longer. When the final cast is removed, a club foot brace is fitted – a pair of shoes attached to an adjustable bar at a specific width and angle. The child wears these at night for four years.” The method can be started from birth up to almost any age, and if it fails, it is repeated and only if it fails again, would surgery be considered.