Clubfoot

Clubfoot

What is clubfoot?

Clubfoot, also known as talipes equinovarus, is a condition where a baby is born with one or both feet positioned differently from usual. The foot typically points downwards and turns inwards, with the sole of the foot facing towards the other foot or, in more pronounced cases, upwards.

Clubfoot is related to differences in the muscles, tendons and ligaments around the foot and lower leg, which affect the position and movement of the foot.

Clubfoot can affect one or both feet and varies in severity from child to child.

What causes clubfoot?

In many children, the exact cause of clubfoot is not known. This is known as idiopathic clubfoot and is the most common form.

Genetic and environmental factors may play a role, and having a family history of clubfoot can increase the likelihood of a child being affected.

Clubfoot can also occur alongside other conditions, including:

• Cerebral palsy

• Spina bifida

• Arthrogryposis

• Neuromuscular conditions

• Certain genetic or syndromic conditions

When clubfoot occurs alongside another condition, it may be described as neurogenic or syndromic clubfoot.

Who is affected by clubfoot?

Clubfoot is present at birth and may sometimes be identified during pregnancy through an ultrasound scan. It is also assessed as part of a baby's newborn examination.

Clubfoot is more common in boys and can affect one or both feet.

Most children with idiopathic clubfoot do not have another underlying condition and can go on to develop good function following appropriate treatment.

What does clubfoot look like?

The position of the foot can vary depending on the severity of the condition. It may:

• Point downwards

• Turn inwards

• Have the sole facing towards the other foot

• Have a higher-than-usual arch

• Have a curved appearance through the front of the foot

• Have reduced movement or stiffness

• Be smaller than the unaffected foot

• Be associated with a smaller calf on the affected side

The appearance and flexibility of the foot can change throughout treatment and development.

How is clubfoot treated?

The main treatment for most babies with idiopathic clubfoot is the Ponseti method, which is led by an orthopaedic specialist.

Treatment usually involves:

• Gentle manipulation of the foot

• A series of plaster casts to gradually improve the position of the foot

• An Achilles tendon procedure for some children

• A foot-abduction brace to help maintain the correction and reduce the risk of relapse

Bracing is an important part of the Ponseti treatment pathway, and families are supported by their orthopaedic and orthotic teams throughout this process.

Where does physiotherapy fit in?

Physiotherapy can complement, but does not replace, the child's orthopaedic and orthotic treatment.

Our physiotherapists can support a child's movement and development during and after clubfoot treatment, helping them develop the strength, balance, coordination and functional skills they need for everyday activities.

How can clubfoot affect movement and development?

Casting and bracing can temporarily affect how freely a baby or child can move their legs and feet.

As children grow, it is important to support opportunities to develop skills such as:

• Rolling

• Reaching and pushing up

• Sitting

• Crawling

• Pulling to stand

• Standing independently

• Taking their first steps

• Walking

• Running and jumping

• Participating in play and sport

Differences in ankle movement, foot position, calf strength or balance can sometimes affect a child's walking pattern and ability to participate in activities.

The affected foot and calf may also remain smaller than the unaffected side.

How can physiotherapy help children with clubfoot?

Physiotherapy is tailored to the child's age, development, treatment stage and individual goals.

Depending on the child's needs, physiotherapy may focus on:

Supporting movement and mobility

We can help children develop the movement skills they need to progress through different developmental stages, from early movement and floor play through to standing, walking, running and jumping.

Strength and motor control

Activities can help develop strength and control through the legs, feet and wider body, supporting functional movement and participation.

Balance and coordination

As children begin standing and walking, physiotherapy can help develop balance, weight shifting and coordination through play-based activities.

Gait and walking

For children who are walking, we can assess their gait and look at how the foot, ankle, knee and wider body are working together.

Where appropriate, activities can be used to support walking quality, confidence and endurance.

Flexibility and movement

Where this forms part of the child's treatment plan, physiotherapy may include appropriate movement and stretching activities to support functional range of movement.

Supporting participation

Our aim is not simply to work on individual movements. We want children to be able to use their developing skills in everyday life — whether that means playing with friends, getting around school, joining in with sport or becoming more independent.

Can physiotherapy help with the clubfoot brace routine?

Bracing is an important part of clubfoot treatment and is managed by the child's orthopaedic and orthotic team.

Physiotherapy can support the child and family by considering how the brace routine affects movement, positioning, play and development.

We can help parents find ways to encourage appropriate movement and play within the child's treatment plan.

If there are concerns about the fit of the brace, skin, foot position or whether the foot is maintaining its correction, these should be discussed with the child's orthopaedic or orthotic team.

Monitoring progress and relapse

Clubfoot can sometimes relapse, even after successful initial treatment.

Regular monitoring by the child's orthopaedic team is therefore important.

Physiotherapy can also help monitor functional changes such as:

• Foot and ankle movement

• Strength

• Balance

• Walking pattern

• Running and jumping

• Functional mobility

• Participation in everyday activities

If changes are identified, these can be communicated with the wider team so that appropriate assessment can take place.

Specialist equipment at Positive Steps

At Positive Steps, we have a range of specialist rehabilitation equipment that can be incorporated into a child's physiotherapy programme where appropriate.

Equipment is selected according to the child's age, stage of treatment, abilities and goals and forms part of a wider programme of play-based and functional rehabilitation.

EzyGain Treadmill

The EzyGain treadmill can be used to support walking development and gait rehabilitation.

For a child who is beginning to walk or developing their walking pattern following clubfoot treatment, the treadmill can provide a controlled environment to practise stepping and walking with appropriate support.

It may also be used to observe aspects of walking and help develop strength, balance, coordination and confidence.

BlazePods

BlazePods can be used to create interactive and play-based activities that encourage reaching, stepping, balance, coordination and reactions.

The position and speed of the targets can be adapted to the child's abilities, allowing activities to become progressively more challenging as their balance, coordination and confidence develop.

For children with clubfoot, BlazePods can be incorporated into standing, stepping and walking activities to encourage weight shifting and active movement.

Hypervibe

The Hypervibe uses whole-body vibration and may be incorporated into a child's rehabilitation programme where clinically appropriate. Depending on the child's individual needs and stage of development, it may be used alongside other activities to support muscle activation, strength, balance and weight-bearing.

Choosing the right equipment

Not every child with clubfoot will need or benefit from every piece of equipment.

Our physiotherapists assess each child's presentation, stage of treatment and individual goals before deciding which equipment or activities may be appropriate.

Our equipment is used alongside hands-on therapy, play-based activities, functional practice and advice for parents and carers to create an individualised rehabilitation programme.

Hydrotherapy

Hydrotherapy can provide a supportive environment for children who are developing their strength, balance and mobility.

The buoyancy of the water reduces the amount of weight placed through the feet and legs, which can make it easier for some children to practise standing, stepping, walking and changing position.

The resistance of the water can also be used to develop strength and movement control. Play-based activities, such as reaching for objects, stepping through the water or moving between different positions, can help make therapy engaging while working towards functional goals.

Clubfoot physiotherapy at Positive Steps

At Positive Steps, we understand that every child develops at their own pace.

Our paediatric physiotherapists work with children at different stages of clubfoot treatment and development, from babies undergoing casting and bracing through to toddlers learning to stand and walk and older children developing their strength, balance, running, jumping and sporting skills.

Sessions are designed around the individual child and their interests, using purposeful play and functional activities to help them work towards meaningful goals.

Our approach may include:

• Supporting early motor development

• Developing strength and motor control

• Improving balance and coordination

• Supporting standing and walking

• Developing gait, running and jumping skills

• Encouraging participation in play, school and sport

• Supporting parents and carers with activities at home

• Working alongside the child's wider healthcare team

Working alongside your child's wider team

Clubfoot treatment is often multidisciplinary.

Depending on the child's needs, this may involve an orthopaedic specialist, orthotist, physiotherapist and other healthcare professionals.

At Positive Steps, we work alongside the child's existing medical and orthotic care rather than replacing it. Our role is to support the child's movement, development, function and participation throughout their treatment journey.

Can physiotherapy help my child with clubfoot?

Yes. Physiotherapy can support children with clubfoot by helping them develop the strength, balance, coordination, movement and functional skills needed for everyday activities.

The exact physiotherapy programme will depend on the child's age, treatment stage, presentation and individual goals.

Early and appropriate clubfoot treatment generally provides children with a good opportunity to develop useful function. Physiotherapy can help support them as they progress through important developmental and functional milestones.

At Positive Steps, we focus on what can be done and work with each child and family to help them move, play and participate as independently as possible.

Find out more about clubfoot

If your child has been diagnosed with clubfoot, your child's orthopaedic team will be able to provide advice about their individual treatment plan.

For additional information and support, you may find the following organisations useful:

• NHS – information about clubfoot and treatment

• STEPS Charity – support and information for children and families affected by lower-limb conditions

• Ponseti International Association – information about the Ponseti method and clubfoot treatment

If you would like to discuss how physiotherapy could support your child's movement and development, please contact Positive Steps Physiotherapy.

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