Clubfoot: causes, diagnosis, and treatments for proper foot development

General Introduction
Clubfoot is a congenital foot deformity present at birth, characterized by an abnormal alignment of the foot in relation to the leg. Specifically, the foot appears rotated inward and downward, making normal plantar support difficult.

As one of the most common pediatric orthopedic deformities, clubfoot requires early diagnosis and timely treatment to ensure proper development of walking ability. Thanks to therapeutic advances, clubfoot can now be treated with high success rates, significantly reducing the risk of future functional limitations.

Definition and Characteristics of Clubfoot
Clubfoot, technically known as congenital clubfoot, is a complex deformity involving bones, joints, muscles, and tendons of the foot. The most common form is equinovarus-adducted-supinated clubfoot, characterized by:

• Equinus: the foot points downward.

• Varus: the heel is deviated inward.

• Adduction: the forefoot is rotated medially.

• Supination: the sole of the foot turns inward.

Clubfoot may affect one foot (unilateral) or both feet (bilateral). If left untreated, the deformity can significantly impair walking ability.

Causes and Risk Factors
The exact causes of clubfoot are not always clearly defined. In most cases, it is idiopathic, meaning there is no identifiable specific cause. However, several associated factors have been identified:

1. Genetic predisposition or family history.

2. Alterations in fetal development.

3. Reduced intrauterine space.

4. Association with neuromuscular disorders (in more complex cases).

It is important to distinguish congenital clubfoot from other foot positioning conditions that may appear similar but are milder and often temporary.

Symptoms and Impact on Quality of Life
In newborns, clubfoot is immediately visible due to the abnormal foot position. It is generally not painful at birth, but without treatment it may lead to:

• Difficulty walking.

• Improper foot support.

• Abnormal callus formation.

• Postural alterations of knees, hips, and spine.

• Functional limitations in adulthood.

Untreated clubfoot can result in painful and unstable gait, with long-term consequences on quality of life and personal independence.

Diagnosis of Clubfoot
Diagnosis is primarily clinical and made at birth through direct observation. It may also be detected during pregnancy via morphological ultrasound.

The diagnostic pathway includes:

• Neonatal orthopedic evaluation.

• Assessment of foot mobility.

• Radiographic investigations in more complex cases.

Early diagnosis allows treatment to begin within the first weeks of life, when tissues are more elastic and responsive to correction.

Available Treatments

Conservative Treatment (Ponseti Method)
The first-line treatment is the Ponseti method, which involves:

• Progressive manual manipulation of the foot.

• Weekly application of corrective casts.

• Possible minor Achilles tendon release (percutaneous tenotomy).

• Use of maintenance braces (Mitchell braces) to prevent relapse and continue correction.

In most cases, this approach achieves effective correction without the need for major surgery.

Role of Braces and Orthoses
After the initial correction phase, maintenance is essential. The use of orthopedic braces (Mitchell braces) helps stabilize foot growth in the correct position and reduce the risk of recurrence.

The orthopedic technician plays a key role in fitting orthotic devices, ensuring comfort, proper fit, and adequate biomechanical function, as well as manufacturing custom braces when necessary.

Surgical Treatment
In resistant cases or significant relapses, more complex surgical intervention may be required to correct bone and tendon structures. However, thanks to current protocols, extensive surgery is increasingly rare.

Conclusions
Clubfoot is a congenital deformity that requires early diagnosis and specialist treatment. With modern therapeutic protocols—particularly the Ponseti method and the use of specific orthoses—excellent functional outcomes can be achieved.

Intervening within the first weeks of life, consistently following therapeutic guidelines, and relying on a specialized multidisciplinary team are key factors in ensuring harmonious growth and proper walking development over time.

Thanks to advances in conservative techniques, clubfoot now has a high therapeutic success rate. Future perspectives include improved orthotic materials, increasingly personalized follow-up protocols, and integrated multidisciplinary approaches.