7 Key Symptoms of Clubfoot: Signs and Physical Indicators

Clubfoot, medically known as talipes equinovarus, is a congenital birth defect that affects the position and structure of one or both feet. This condition occurs when a baby’s foot is twisted out of shape or position, typically turning inward and downward. Clubfoot is one of the most common musculoskeletal birth defects, affecting approximately 1 in every 1,000 newborns worldwide. The condition is usually identified at birth or even during prenatal ultrasound examinations.

Understanding the symptoms of clubfoot is crucial for early detection and timely intervention. While clubfoot doesn’t cause pain in infants, if left untreated, it can lead to significant complications as the child grows, including difficulty walking, limited mobility, and potential arthritis. The severity of clubfoot can vary from mild and flexible to severe and rigid, which influences the treatment approach and prognosis.

In this comprehensive guide, we’ll explore the characteristic symptoms and physical signs that define clubfoot, helping parents and caregivers recognize this condition and understand what to look for in affected infants.

1. Inward Rotation of the Foot

The most distinctive and immediately noticeable symptom of clubfoot is the abnormal inward rotation of the affected foot. In this condition, the foot turns inward at the ankle, resembling the head of a golf club, which is where the condition gets its name.

The inward rotation is characterized by:

• Medial deviation: The front part of the foot points toward the opposite foot rather than forward
• Supination: The sole of the foot faces inward or even upward in severe cases
• Persistent positioning: Unlike normal positional variations in newborns, this rotation cannot be easily corrected by gentle manipulation
• Fixed deformity: The foot remains in this twisted position and resists passive correction

This inward rotation affects the entire foot structure, involving bones, joints, muscles, and tendons. The degree of rotation can vary from mild cases where the foot shows slight turning to severe cases where the foot is dramatically twisted inward, sometimes even touching the opposite leg.

2. Downward Pointing of the Toes (Equinus Position)

Another hallmark symptom of clubfoot is the equinus position, where the foot points downward, similar to the position of standing on tiptoes. This downward pointing is caused by tightness in the Achilles tendon and calf muscles.

Key characteristics of this symptom include:

• Plantarflexion: The foot is flexed downward at the ankle joint, with the toes pointing away from the shin
• Limited dorsiflexion: The foot cannot be brought up toward the shin in a normal range of motion
• Heel elevation: The heel appears elevated and cannot rest flat against a surface
• Toe prominence: The toes may appear more prominent as they point downward

This equinus deformity contributes to the overall appearance of the clubfoot and affects how the foot would contact the ground. If left untreated, children with this symptom would attempt to walk on the outer edge or even the top of their foot rather than on the sole.

3. High Arch (Cavus Deformity)

Children born with clubfoot typically exhibit an abnormally high arch in the affected foot. This symptom, known as cavus deformity, creates an exaggerated curve along the inner side of the foot from heel to toes.

This high arch presents with several observable features:

• Deep crease: A pronounced crease or fold appears on the sole of the foot at the arch area
• Elevated midfoot: The middle portion of the foot is abnormally elevated compared to the heel and toes
• Shortened foot appearance: The foot may appear shorter due to the excessive curvature
• Taut skin: The skin along the outer edge of the foot may appear stretched, while the inner side shows excess folding

The high arch is caused by muscle imbalances and contractures that pull the heel and front of the foot closer together, creating this distinctive curved appearance. This symptom contributes to the overall rigidity of the clubfoot and affects the foot’s ability to function normally.

4. Heel Rotation and Varus Position

The heel in clubfoot demonstrates a characteristic inward rotation known as varus positioning. This symptom involves the heel turning inward toward the midline of the body rather than maintaining its normal alignment.

Specific manifestations of heel rotation include:

• Inverted heel: When viewed from behind, the heel appears tilted inward rather than straight
• Underdeveloped heel bone: The calcaneus (heel bone) may appear smaller and differently shaped
• Difficulty palpating: The heel may be difficult to feel or locate due to its abnormal position
• Posterior displacement: The heel may also be pulled upward and backward

This heel deformity is a critical component of clubfoot and significantly contributes to the overall dysfunction. The abnormal heel position affects the ankle joint’s mechanics and would prevent normal weight-bearing if not corrected.

5. Calf Muscle Underdevelopment

A noticeable symptom in children with clubfoot is the underdevelopment or atrophy of the calf muscles on the affected side. This symptom becomes more apparent as the child grows and is particularly visible in unilateral (one-sided) clubfoot cases.

The calf muscle underdevelopment presents as:

• Reduced muscle mass: The calf appears noticeably thinner compared to the unaffected leg
• Decreased circumference: Measurements show smaller calf circumference on the clubfoot side
• Less defined contour: The normal muscle definition and shape of the calf are diminished
• Persistent difference: This size difference often persists even after successful treatment

This muscle underdevelopment occurs due to several factors, including the abnormal position preventing normal muscle development, reduced movement and use of the affected foot, and potentially inherent differences in muscle tissue. While treatment can improve function, some degree of calf size difference may remain permanent in many cases.

6. Stiffness and Reduced Flexibility

Clubfoot is characterized by significant stiffness in the affected foot and ankle. Unlike normal positional foot variations that can be gently moved into correct alignment, clubfoot demonstrates marked resistance to manipulation.

This stiffness manifests through:

• Limited passive range of motion: When a healthcare provider attempts to move the foot into a normal position, there is significant resistance
• Tight soft tissues: Tendons, ligaments, and joint capsules are contracted and shortened
• Rigid positioning: The foot springs back to its deformed position when released after attempted correction
• Resistance across multiple joints: Stiffness affects the ankle, subtalar, and midfoot joints simultaneously

The degree of stiffness varies among individuals and is an important factor in determining treatment approaches. More rigid clubfoot cases may require more intensive intervention compared to more flexible presentations. This stiffness is not painful for the infant but represents structural changes in the foot’s soft tissues and bones.

7. Shortened Foot Length

Babies born with clubfoot typically have an affected foot that is shorter than normal or shorter than the unaffected foot in unilateral cases. This shortened appearance is a visible symptom that contributes to the overall deformity.

The shortened foot presents with these characteristics:

• Measurable length difference: The affected foot measures shorter from heel to toe compared to normal standards or the other foot
• Proportional reduction: All components of the foot may appear proportionally smaller
• Persistent size difference: Even with treatment, the affected foot may remain slightly smaller throughout life
• Compacted appearance: The foot appears compressed or bunched together due to the various deformities

This shortening results from the combination of all the other deformities: the high arch brings the heel and toes closer together, the inward rotation compresses the foot structure, and underdevelopment of bones and soft tissues contributes to the overall reduced size. While treatment can improve the foot’s length and appearance, some degree of size difference may persist, particularly in more severe cases.

Main Causes of Clubfoot

The exact cause of clubfoot remains unclear in most cases, but research has identified several potential contributing factors:

Genetic Factors

Clubfoot tends to run in families, suggesting a genetic component. If one parent has clubfoot, there is approximately a 3-4% chance their child will be affected. If one child in a family has clubfoot, the risk for subsequent children increases. Researchers have identified several genes that may be associated with clubfoot development, though no single gene has been definitively identified as the cause.

Environmental Factors During Pregnancy

Certain environmental exposures during pregnancy may increase the risk of clubfoot:

• Smoking: Maternal smoking during pregnancy, particularly in the first trimester, has been associated with increased clubfoot risk
• Certain medications: Some medications taken during early pregnancy may increase risk
• Illicit drug use: Use of certain drugs during pregnancy has been linked to higher clubfoot incidence
• Inadequate amniotic fluid: Oligohydramnios (too little amniotic fluid) may restrict fetal movement and contribute to clubfoot development

Abnormal Fetal Development

Clubfoot may result from abnormal development of muscles, tendons, and bones during fetal growth. This could involve arrested development at a certain stage, with the foot failing to develop into its normal position. Problems with the nerves and blood vessels supplying the foot may also play a role.

Associated Conditions

Clubfoot can occur as an isolated condition (idiopathic clubfoot) or in association with other conditions:

• Spina bifida: Neural tube defects may be associated with clubfoot
• Arthrogryposis: This condition involving joint contractures often includes clubfoot
• Congenital myopathies: Muscle disorders present at birth may include clubfoot as a feature
• Chromosomal abnormalities: Certain genetic syndromes include clubfoot among their features

Mechanical Factors

Physical constraint in the uterus may contribute to clubfoot development in some cases. Factors that limit fetal movement, such as unusual fetal positioning, multiple gestations (twins or triplets), or uterine abnormalities, may increase risk.

In most cases of idiopathic clubfoot (approximately 80% of cases), no specific cause can be identified, and the condition is likely multifactorial, involving a combination of genetic predisposition and environmental influences.

Frequently Asked Questions

Can clubfoot be detected before birth?

Yes, clubfoot can often be detected during routine prenatal ultrasound examinations, typically during the second trimester (around 18-20 weeks of pregnancy). However, ultrasound detection is not always accurate, and some cases may not be identified until birth. Prenatal diagnosis allows parents to prepare and consult with specialists before delivery.

Is clubfoot painful for babies?

No, clubfoot is not painful for infants and young babies. The condition affects the position and structure of the foot but does not cause discomfort in newborns. However, if left untreated, clubfoot can lead to pain and significant functional problems as the child grows and attempts to walk.

Does clubfoot affect both feet or just one?

Clubfoot can affect one foot (unilateral) or both feet (bilateral). Approximately 50% of cases are bilateral, meaning both feet are affected. In unilateral cases, the right foot is slightly more commonly affected than the left. Boys are affected approximately twice as often as girls.

Can clubfoot resolve on its own without treatment?

No, true clubfoot will not resolve on its own and requires treatment. It’s important to distinguish clubfoot from positional foot deformities that result from the baby’s position in the womb, which are flexible and often resolve without intervention. True clubfoot is characterized by stiffness and structural changes that do not improve without appropriate treatment.

At what age should clubfoot treatment begin?

Treatment for clubfoot should begin as soon as possible after birth, ideally within the first week or two of life. Early treatment takes advantage of the infant’s flexible bones, ligaments, and tendons, which can be more easily manipulated and corrected. Starting treatment early generally leads to better outcomes and may reduce the need for more invasive interventions.

Will a child with treated clubfoot be able to walk normally?

With appropriate and timely treatment, most children with clubfoot can walk normally or near-normally and participate in regular activities, including sports. The success of treatment depends on several factors, including the severity of the clubfoot, how early treatment begins, adherence to the treatment plan, and whether any associated conditions are present. Some children may have slight limitations in ankle flexibility or minor cosmetic differences, but most achieve functional and active lifestyles.

Is clubfoot associated with other health problems?

In most cases (about 80%), clubfoot occurs as an isolated condition without other health problems. However, in some cases, clubfoot may be associated with other congenital conditions, such as spina bifida, arthrogryposis, or certain genetic syndromes. If clubfoot is detected, healthcare providers will typically examine the child for other potential abnormalities to ensure comprehensive care.

Can clubfoot come back after treatment?

There is a risk of clubfoot recurrence even after successful treatment, particularly if post-treatment protocols are not followed carefully. Recurrence is most common if children do not wear prescribed braces as directed following initial correction. The risk of recurrence is highest in the first few years of life. If recurrence occurs, additional treatment may be necessary to restore proper foot position and function.

References:

• Mayo Clinic – Clubfoot: Symptoms and Causes
• Johns Hopkins Medicine – Clubfoot
• American Academy of Orthopaedic Surgeons – Clubfoot
• Boston Children’s Hospital – Clubfoot
• NHS – Club Foot
• Stanford Children’s Health – Clubfoot