Clubfoot is a condition present at birth in which a baby’s foot points downwards and inwards. It is a common condition affecting as many as 2 out of every 1,000 live births. Clubfoot is not painful for infants, but without treatment, it can limit their ability to walk and be active and can eventually lead to pain. With early and appropriate treatment, most children born with clubfoot can walk, run, and play with little or no lasting effects.

Clubfoot is a structural deformity of the foot and ankle that is present at birth. In this condition, the tendons that connect the muscles of the leg to the bones of the foot are tight and short, and there is a muscle imbalance. This causes the foot to turn inward, and the bottom of the foot may face sideways or even upward. In addition, the foot may be less flexible or even rigid. The medical term for clubfoot is congenital talipes equinovarus.

The main features of clubfoot include:

• high arch in the middle of the foot (called midfoot cavus)
• sharp angle to the front part of the foot (forefoot adductus)
• inward tilt of the heel (hindfoot varus)
• downward point to the foot (hindfoot equinus)

Clubfoot can affect one (usually the right foot) or both feet. In about half of cases, clubfoot involves both feet. Underdeveloped muscles cause the foot and leg to be shorter and the calf thinner than usual. This is more noticeable in children who have only one affected foot.

The severity of clubfoot can range from mild to severe, but all forms require treatment to prevent long-term disability.

While the precise reasons for clubfoot remain unclear, experts think both inherited and environmental influences play a role in the condition. In most children, no specific cause is found, and they have no other health concerns.

Family patterns suggest that genetics are involved; roughly one in four children with clubfoot have relatives who also had the condition. Certain exposures or health issues during pregnancy—such as smoking, alcohol use, or diabetes—might raise the chance of clubfoot, but these connections are not yet confirmed.

Types of clubfoot include:

• Idiopathic, which occurs in otherwise healthy children (the most common type of clubfoot)
• Syndromic, or related to other genetic or birth conditions
• Neuromuscular, linked to nervous system disorders such as spina bifida

Sometimes, the baby’s position in the womb can cause a related problem called “positional clubfoot.” This is not true clubfoot and usually corrects itself after birth.

Certain factors may raise the risk of clubfoot, including:

• Family history of the condition, including a sibling also born with clubfoot
• Presence of certain genetic or neuromuscular disorders
• Maternal health or exposures during pregnancy, such as having diabetes, smoking, or using alcohol

Boys are about twice as likely as girls to be born with clubfoot, and twins are also more likely to be affected, especially identical twins.

The main sign of clubfoot is the abnormal position of one or both feet at birth that is not flexible. Signs and symptoms include:

• Stiffness in the foot that makes it difficult to move
• High arch or deep skin crease in the foot
• Slimmer calf muscles
• In one-sided cases, the affected foot is smaller and the leg is shorter than the unaffected leg

If untreated, children with clubfoot experience pain and difficulty upon walking, which can limit activity. They also may not be able to wear regular shoes.

Doctors diagnose clubfoot through a physical exam.

The doctor will ask about any family history of clubfoot or related conditions and may ask about the mother’s health or details of her pregnancy. During the physical exam, the doctor will look at the position and flexibility of the baby’s feet and legs. The doctor may also check for differences in muscle size and foot length and the presence of skin creases on the foot. In some cases, the doctor will look for other conditions that can be linked to clubfoot, such as neurological disorders.

Tests that may be used include:

• Prenatal ultrasound: Clubfoot can sometimes be detected before birth during a routine ultrasound, often as early as the second trimester. However, not all cases are found this way, and some may be missed or mistaken for normal fetal positioning.
• Imaging tests: X-rays are not usually needed in newborns but may be used in older children or if the diagnosis is unclear or to monitor effectiveness of treatment. Ultrasound and MRI are less commonly used, but they can provide more detail about the bones and soft tissues, especially in complex or recurrent cases.
• Genetic testing: If clubfoot is associated with other abnormalities or suspected syndromes, genetic tests may be recommended to look for underlying causes.

Based on the findings of the physical exam and testing, doctors may use a scoring system, such as the Pirani or Dimeglio classification, to measure the severity of the deformity and guide treatment.

Most cases of clubfoot are treated with nonsurgical methods, such as casts, braces, and stretching. Treatment is usually successful, especially when started soon after birth and when adhered to carefully.

Treatment approaches include:

• Ponseti method: This is the most widely used and effective treatment, reaching success rates of 80% to 95%. This method involves gently stretching and repositioning the foot, then holding it in place with a cast. The cast is changed every week for about six to eight weeks. Most children also need a minor procedure called Achilles tenotomy, where the tight tendon at the back of the ankle is lengthened to improve flexibility. After casting, the child wears a brace to keep the foot in the correct position and prevent the condition from coming back. The brace typically consists of boots connected by a bar that holds the feet in place. The choice of brace depends on the baby’s needs and the extent of the condition. The baby wears the brace full-time at first, then at night and during naps for several years.
• Surgery: Surgery may be recommended if nonsurgical treatments do not fully correct the deformity or if the clubfoot returns. Surgical options may include lengthening or moving tendons, releasing tight ligaments, or more extensive procedures to correct the bones and joints. Surgery can make the foot stiffer and is generally reserved for severe or treatment-resistant cases.
• Ongoing care: Children with clubfoot need regular follow-up visits to monitor progress and adjust treatment as needed. Physical therapy may help improve strength and flexibility.

Early and consistent treatment is key to achieving the best outcome, and most children can walk, run, and play normally.

Clubfoot and its treatment can lead to several complications, especially if the condition is not managed properly or if the child does not wear the cast and brace as recommended. Recurrence is the number one complication and commonly occurs when the child does not receive adequate treatment or does not wear the brace or cast for long enough.

An improperly fitted brace or cast can cause skin irritation and other problems. If toes swell, change color, disappear into the cast, or if the cast causes significant pain or slides off, contact the care team promptly so the cast can be removed and re-fitted, and the child can continue wearing it as directed.

Other complications can include lingering stiffness or pain and muscle weakness, even after treatment. If only one leg/foot is affected, one leg may be shorter than the other and the foot smaller. Some people have continued issues with getting properly fitting shoes. Surgery, if needed, carries risks like infection or overcorrection.

With early and proper treatment, most complications can be prevented or managed effectively.

Most children with clubfoot who receive early and consistent treatment have an excellent outlook. They can walk, run, and participate in most activities without pain or major limitations. The affected foot is usually a little smaller and less flexible than the other side, and the calf muscle may remain thinner. Some children may tire more easily or have mild soreness after activity, but these issues are usually minor. Regular follow-up is important to monitor growth and development, especially during the early years. There are top professional and Olympic athletes in many sports who have clubfoot.

A small number of children with clubfoot may need additional treatment or surgery. Children with clubfoot as part of another condition or syndrome may have more challenges and require more complex care.

With proper management, most children born with clubfoot can lead active, healthy lives. The outlook is less favorable if clubfoot is not treated or if treatment is delayed, as this can lead to lifelong disability and pain. Early diagnosis and a team approach to care help ensure the best possible outcome.

“The Yale Clubfoot Program is a regional center for expertise in the treatment of clubfoot,” says Adrienne Socci, MD, a pediatric orthopedist who treats problems ranging from broken bones to congenital conditions. “With a team that includes a physician, physician assistant, nurses, and a child life specialist, the clubfoot team is dedicated to caring for newborns and children with this condition while supporting families and helping them navigate what can be a challenging and stressful time. We guide each baby and family through the early casting period and subsequent bracing with close attention to their individual needs. An on-site orthotist makes the transition to bracing seamless. From the first prenatal conversation, we put expecting parents in touch with another clubfoot family, offering an opportunity for local support and advice. We believe that the best outcomes require a strong foundation for families, including understanding the condition and how to achieve the best possible outcome.”