Clubfoot

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What is clubfoot?

Clubfoot is when babies are born with 1 foot or both feet pointing down and in. Their toes point toward the other leg, and the bottoms of their feet face inward. In some cases, it looks like the baby’s foot is upside down.

A clubfoot cannot be straightened simply by moving it around. The   and on the inside and back of the foot and ankle are shorter than usual. Those on the outside and front are stretched out. This holds the baby’s foot in its unusual position.

Clubfoot does not get better on its own. If it is not treated, it can cause discomfort and keep your child’s foot from working well as they grow up. But with treatment, there is an excellent chance that your baby’s foot will look good and work very well.

About half of children with the condition have 2 clubfeet. Children with certain and conditions are more likely to have clubfoot. Most times children who have clubfoot are otherwise completely healthy.

What causes clubfoot?

About 1 in every 1,000 babies is born with clubfoot. Clubfoot does not have anything to do with the baby’s position in the womb. It is mostly a problem passed from parents to children (genetic), and it may run in families. If you have 1 baby with clubfoot, the chances of having a second child with the condition are about 1 in 40.

Clubfoot Care at Seattle Children's

For decades, orthopedic surgeons at Seattle Children’s have treated more children with clubfeet than any other center in the Northwest.

What are the symptoms of clubfoot?

At birth, the baby’s foot or feet are turned down and in. They can’t be straightened just by trying to move the feet.

How is clubfoot diagnosed?

Doctors can see clubfoot on images taken after about 4 months of pregnancy.

At birth, a doctor will examine your baby’s feet, arms, hands, hips and legs.

Babies who have a clubfoot are no more likely than other children to have other bone or joint problems unless they have an underlying condition such as or .

How is clubfoot treated?

We treat clubfoot using the Ponseti method. The Ponseti method corrects the problem with the least amount of surgery and sometimes with no surgery at all.

Beginning treatment

We begin gently stretching your baby’s foot toward the correct position soon after birth. After about a 1-minute stretch, we apply a cast that goes from the hip to the toes.
We work with your baby each week, gently stretching the foot farther and putting on a new full-leg cast.
After 4 to 8 weeks of treatment, about 5% to 10% of babies’ clubfeet are completely corrected. Most other babies need a simple procedure in the clinic to release the tight tendon at the back of their ankles (). These babies wear a final cast for about 3 weeks.

Ongoing treatment with a brace

After your baby’s foot is in the correct position, they wear a brace nearly all the time for the next 3 months. Then they wear a brace at night and nap times for 3 to 4 years. The brace, made of leather shoes connected by a metal bar, turns your child’s feet outward.
It is important to use the brace to make sure your child’s feet stay in the new position. Read more about braces and our other orthotics and prosthetics services.
After this treatment, most children need no further treatment. About 2 or 3 children in every 10 will need a minor surgery after age 3 to adjust their tendons.

Partnering with your care team

Your participation during treatment with the Ponseti method is very important. If your child doesn’t wear the brace as directed, the clubfoot is likely to return.
Our doctors and staff are ready to help you with all aspects of the treatment method, including how to care for a baby in casts and braces. We have helped hundreds of families whose children are having Ponseti clubfoot treatment. We are ready to share our expertise and extensive experience with you.

Surgery for clubfoot

The Ponseti method doesn’t work in about 5% to 10% of babies with clubfoot. These children may need major surgery. We are very experienced in these techniques too.
After surgery, physical therapy can help a child become able to place their feet flat on the floor and learn to walk with the feet in this new position. We have the largest team of physical therapists in the Pacific Northwest who specialize in the care of babies, children, teens and young adults.

Why choose Seattle Children’s for clubfoot treatment?

The experts in our  Foot and Ankle Deformities Program, which is part of Orthopedics and Sports Medicine, treat clubfoot.

For decades, orthopedic surgeons at Seattle Children’s have treated more children with clubfeet than any other center in the Northwest. As techniques to treat the problem have changed, we have been at the forefront in learning, using and promoting the latest advances.

Approved practitioners of the Ponseti treatment method
- Ignacio Ponseti developed the Ponseti treatment method for clubfeet at the University of Iowa many decades ago. This method corrects most clubfeet without major surgery, a big change from treatment methods that were common at the time of Dr. Ponseti’s initial work. Because the Ponseti method works well over the long term, it is the leading treatment for clubfoot around the world.
- Our doctors were among the first outside of Iowa to learn the method directly from Dr. Ponseti. We were the first in the Northwest to offer the Ponseti method for clubfoot treatment. We are listed as approved practitioners.
- We have been leaders in teaching the technique to other orthopedic surgeons at national and international conferences, as well as through publications.
- To read more about the Ponseti method, visit Global-HELP, a nonprofit health information website started by the former director of our Department of Orthopedics, Dr. Lynn T. Staheli.
The experts you need are here
- Our Foot and Ankle Deformities team includes experienced pediatric orthopedic surgeons, , and nurses who know how to evaluate and treat all types of foot and ankle conditions.
- We can successfully treat clubfoot in most children with the Ponseti method, using casts and braces. Most children with clubfoot do not need surgery.
- We recommend surgery only when we believe it will give your child the best results. For those who need surgery, we have pediatric orthopedic surgeons with expanded fellowship training in foot and ankle conditions.
- We have the largest group of board-certified pediatric radiologistsin the Northwest. For imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images.
- If your child is diagnosed with clubfoot before birth based on an , we offer prenatal consultations to talk with you about your baby’s condition.
Support for your whole family
- Having a child with a foot or ankle condition can be stressful for the whole family. From the first visit to follow-up, our team will work to give your child seamless care and make your experience here as easy on you as we can.
- Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options. We support you in making choices that are right for your family.
- Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Centerand Guest Services are here to help.
Research to improve care
- Seattle Children’s is active in the Pediatric Foot Research Group, an international group of researchers studying foot and ankle differences in children.
- We take part in national studies to refine clubfoot treatment and improve results for children with this condition. For example, we are studying the effects of clubfoot casting on the shape of bones in the foot. Our growing research program is funded in part by the Lynn Taylor Staheli Endowed Chair in Pediatric Orthopedics.
- Outcomes research helps us know which treatments work best. For example, we use tools to ask children about their function after surgery for limb deformities. Asking children about their experience is essential to improving their lives.
- We take part in several registries (databases that collect information about patients who volunteer) so we can work with doctors around the country and the world to better understand orthopedic conditions, such as foot, leg, hand and arm differences.
- Learn more about current orthopedics research at Seattle Children’s.