Club Foot - What is it?

Club foot is an outdated term with many negative connotations, it is now more generally known as talipes (talipes equinovarus). The good news is that medical developments mean this is a condition that can, eventually, be fully resolved in most cases. In this instance we are focusing on the condition occurring in both feet (bilateral).

Bilateral talipes describes a condition experienced from birth where both feet are twisted so that they are flexed downwards and internally rotated, meaning they cannot be placed flat on the ground. In some cases, it is so extreme that the feet appear to be facing backwards or even upside down

This is a relatively common condition with one baby in every 2,000 born with bilateral talipes. An additional 1 in 2,000 will be born with talipes in just one foot.  Males are twice as likely to have the condition as females.

It is important to know that, although it looks disturbing, it is not painful for babies, though it can cause pain later, when the child begins to walk, if it is left untreated.

Additional complications are that the calf muscles are generally underdeveloped and it can result in a slight shortening of the leg or legs. These issues will be addresses in treatment, but neuro and spinal complications can also be a concern that doctors will be looking out for.

How is it diagnosed?

Occasionally talipes can be seen on a 20 week scan, but it is more commonly diagnosed once the baby is born. No treatment can be given before birth anyway.

There is a chance that the talipes could be ‘postural’ – simply resulting from the baby’s position in the womb and will therefore resolve itself*, this is not the same thing as full bilateral talipes equinovarus. Upon discovery, doctors may x-ray the feet and conduct a thorough examination to understand the internal structures before deciding on the exact course of treatment.“Some cases are more severe than others, and some babies may not be diagnosed until they are one or even two years old.”

What does the treatment look like?

40 years ago the results for treating this condition were very poor, but now the UAE primarily uses the Ponseti method and the vast majority of cases are resolved. An operation under general anaesthetic is no longer the usual treatment.

Treatment will usually and ideally start within a few weeks of birth and involves manipulating the foot into a better position and setting it into a plaster cast. The process is repeated weekly for up to eight weeks. Whilst this is uncomfortable and restrictive it is generally not painful.

The next stage is commonly a procedure under local anaesthetic that makes a small cut to the Achilles tendon, releasing the foot into an even more natural position, and then supporting this with splints at night and/or placing baby’s feet into special boots attached to a bar to stop them returning to the original position. This may continue up to 4 years of age.

In extremely severe cases surgery may be required and a full recovery may not be possible, but this is unusual.

Causes

Club foot is mainly idiopathic - the cause is unknown - however if a parent or sibling has suffered with club foot it does increase the likelihood of being born with this condition. If you have one child with club foot, your risk of having a second child with the condition is around 1 in 35.

Smoking and recreational drugs have also been linked to a higher occurrence of this condition. There is also speculation that too little of the fluid that surrounds the baby in the womb may increase the risk of clubfoot.

In a small number of cases, club foot occurs as part of a more serious underlying condition. It may be linked to neuro or skeletal abnormalities, such as spina bifida cystica.

Where to go for support

Bilateral talipes is a condition that requires multiple visits to hospital over an extended period of time and the costs of these in terms of travel, accommodation and food for parents or carers, time off work will add up to a significant sum over the years – particularly in the initial months. Furthermore, should the child require additional walking supports or medical second opinions then being able to afford the option of going private can be reassuring.

Treatment for talipes is often as uncomfortable for the parents as it is for the child and having medical professionals on hand to talk to about any aspect of the treatment or the family’s emotional responses to it can be an invaluable benefit.

Orient EmbryoCare Future Family Insurance is a unique policy that provides expectant mothers with added assurance from the 20 week scan* through to their child's second birthday. Orient EmbryoCare aims to ease the financial impact of unforeseen costs that can result from 14 covered conditions. Including Congenital Heart Disease.

*This type of talipes would not be covered by Orient EmbryoCare. Bilateral talipes, with a minimum treatment of the Ponseti method, is covered by Orient EmbryoCare policies

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