Bilateral clubfoot is a condition that affects both feet at birth, causing them to twist inward or downward instead of pointing straight ahead. It is one of the most common congenital deformities of the foot and can range from mild to severe. Parents often feel worried when their newborn is diagnosed with bilateral clubfoot, but the condition is treatable with proper medical care. Understanding what bilateral clubfoot is, why it occurs, and how it can be managed is essential for ensuring the child’s healthy development and mobility in the future.
Definition of Bilateral Clubfoot
Bilateral clubfoot refers to the presence of clubfoot deformity in both feet. Clubfoot, medically known as talipes equinovarus, is a structural abnormality where the foot is turned inward, and the sole faces sideways or upward. When the condition affects both feet, it is described as bilateral. This condition is usually detected at birth and can sometimes be identified during pregnancy through an ultrasound scan. Although the feet are misshaped, the bones, tendons, and muscles are all present, but they develop abnormally, leading to restricted movement and abnormal positioning.
Causes of Bilateral Clubfoot
The exact cause of bilateral clubfoot is not fully understood, but experts believe it is influenced by a combination of genetic and environmental factors. Some possible causes include
- Genetic predisposition, where a family history of clubfoot increases the chances of occurrence
- Abnormal development of muscles and tendons in the womb
- Restricted space in the uterus that affects the baby’s foot positioning
- Association with neuromuscular disorders such as spina bifida
In most cases, bilateral clubfoot occurs as an isolated condition, meaning it is not linked to any other health problem. However, in certain cases, it may appear along with other congenital syndromes.
Symptoms of Bilateral Clubfoot
The symptoms of bilateral clubfoot are usually visible immediately at birth. Some of the most noticeable features include
- Feet turned inward, with the soles facing each other
- Downward pointing of the toes, resembling the shape of a golf club
- Shorter and tighter Achilles tendon, limiting foot flexibility
- Underdeveloped calf muscles
- Smaller size of the affected feet compared to normal feet
These symptoms can vary in severity, with some children experiencing mild twisting, while others may have severe deformities that interfere with walking if left untreated.
Diagnosis of Bilateral Clubfoot
Diagnosis can occur before or after birth. Prenatal ultrasounds can sometimes reveal the abnormal position of the feet as early as the second trimester. After birth, doctors can usually confirm the diagnosis by physical examination. Imaging tests such as X-rays may be used to assess the severity and structure of the deformity, especially if surgical treatment is being considered.
Complications of Untreated Bilateral Clubfoot
If left untreated, bilateral clubfoot can lead to serious complications, including
- Difficulty walking normally, often leading to walking on the sides or tops of the feet
- Chronic foot pain due to abnormal weight distribution
- Increased risk of arthritis in the feet and ankles
- Difficulty wearing normal shoes
- Psychological and social challenges due to mobility issues
These complications highlight the importance of early diagnosis and prompt treatment.
Treatment Options for Bilateral Clubfoot
The good news is that bilateral clubfoot is treatable, and with proper care, most children can walk and run normally. Treatment typically begins soon after birth to take advantage of the flexibility of the newborn’s bones and joints. The most common treatment methods include
Ponseti Method
The Ponseti method is the most widely used treatment for bilateral clubfoot. It involves gently manipulating and stretching the baby’s feet into the correct position, followed by the application of plaster casts to hold the feet in place. This process is repeated weekly for several weeks until the feet are properly aligned. In many cases, a minor surgical procedure called a tenotomy (cutting of the Achilles tendon) is performed to allow better foot movement. After correction, the child must wear braces or special shoes to prevent recurrence.
French Functional Method
This approach involves daily stretching exercises, taping, and splinting of the feet to gradually correct the deformity. It requires consistent physical therapy sessions and active participation from parents in performing exercises at home.
Surgical Treatment
In severe or resistant cases, surgery may be necessary to lengthen tendons, reposition bones, or release tight ligaments. While surgery can provide correction, it is usually reserved for cases where non-surgical methods fail, as it carries higher risks of stiffness and long-term complications.
Long-Term Management of Bilateral Clubfoot
Treatment does not end once the feet are corrected. Long-term management is essential to prevent relapse. This includes
- Wearing braces or special shoes as prescribed by the doctor
- Regular follow-up visits with an orthopedic specialist
- Physical therapy to strengthen muscles and improve flexibility
- Monitoring the child’s gait and growth to address any recurrence early
Without consistent follow-up, the condition can return, especially within the first few years of life.
Prognosis of Bilateral Clubfoot
With early and appropriate treatment, children with bilateral clubfoot can lead active, normal lives. Most are able to walk, run, and participate in sports without significant limitations. The prognosis is excellent when the condition is treated promptly and managed consistently. However, if treatment is delayed or inconsistent, long-term mobility problems may arise.
Psychological and Social Impact
In addition to physical challenges, bilateral clubfoot can affect a child’s emotional and social well-being if left untreated. Difficulty walking, limited shoe options, and visible deformity may lead to self-consciousness or social withdrawal. Support from family, counseling, and proper medical care help children develop confidence and integrate well into school and social activities.
Prevention and Risk Factors
There is no guaranteed way to prevent bilateral clubfoot, but understanding the risk factors can help with early detection. Risk factors include
- Family history of clubfoot
- Being male, as boys are more commonly affected
- Intrauterine factors such as reduced amniotic fluid or limited space in the womb
- Association with certain genetic syndromes
Parents with a family history of clubfoot may benefit from genetic counseling and early prenatal monitoring.
Bilateral clubfoot is a congenital condition affecting both feet, where the feet turn inward or downward due to abnormal development of muscles, tendons, and bones. While it can be concerning for parents, effective treatments like the Ponseti method make correction possible in most cases. Early diagnosis, prompt intervention, and consistent follow-up care are key to ensuring the child grows up with normal mobility and minimal complications. Understanding what bilateral clubfoot is, its causes, symptoms, and treatment options helps families make informed decisions and gives children the best chance for a healthy and active life.