Discovering that your child has clubfoot can be concerning for any parent. While clubfoot may appear alarming, modern treatment approaches have made it highly manageable, with many children achieving normal foot function and mobility. Our Senior Consultant Orthopaedic Surgeon specialises in paediatric foot conditions and provides comprehensive care tailored to your child’s specific needs.
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Clubfoot, medically known as congenital talipes equinovarus (CTEV), is a birth defect where a baby’s foot is twisted out of shape or position. The affected foot points downward and inward, with the sole facing sideways or even upward. This condition occurs when the tendons connecting leg muscles to foot bones are shorter than normal, pulling the foot into an abnormal position.
The most common form, occurring in otherwise healthy babies with no other medical conditions.
A milder form resulting from the baby’s position in the womb. The foot appears turned but is flexible and can often be gently moved to a normal position. This type usually requires less intensive treatment.
Associated with other conditions such as spina bifida, cerebral palsy, or arthrogryposis. This type may be more rigid and require more complex treatment approaches due to underlying neurological or muscular conditions.
Characterised by a short, stubby foot with deep creases, severe rigidity, and other unusual features. This type often requires modified treatment techniques and may have different outcomes compared to typical idiopathic clubfoot.
The exact cause of clubfoot remains unknown, but research suggests multiple factors contribute to its development:
Clubfoot is typically diagnosed at birth through physical examination, though it can sometimes be detected during prenatal ultrasound scans as early as 20 weeks of pregnancy.
Our Senior Consultant Orthopaedic Surgeon can assess your child’s condition and discuss suitable evaluation and management options.
If your baby is born with clubfoot or if prenatal scans indicate a possible condition, you may consider arranging an assessment soon after birth, ideally within the first few weeks. Parents may also consider seeking evaluation if they notice any foot abnormalities in their newborn, even if clubfoot wasn’t identified at birth.
During the consultation, our Senior Consultant Orthopaedic Surgeon will examine your baby’s feet, assess the condition’s characteristics, and explain potential management options. The appointment may include documenting the feet, measuring range of motion, and discussing suitable treatment approaches in a supportive environment.
Physical examination is the main method for assessing clubfoot. Our orthopaedic surgeon will evaluate the foot’s position, flexibility, and severity using standardised scoring systems such as the Pirani or Dimeglio classification. These assessments help monitor progress and guide treatment decisions.
X-rays are generally not needed for initial diagnosis in newborns because many foot bones are still cartilage. They may be used in older children or complex cases to assess bone alignment and joint relationships. Ultrasound can provide additional information on soft tissue structures and may be used to support certain procedures.
For syndromic clubfoot, additional tests may include genetic screening, spine imaging to check for spina bifida, or hip ultrasound to assess for developmental dysplasia. Prenatal ultrasound can indicate the condition, helping parents prepare for early assessment and management after birth.
A clubfoot treatment involving weekly gentle manipulation and casting. The foot is gradually corrected over 5-7 weeks through serial plaster casts. Each cast holds the foot in an improved position, allowing ligaments to stretch and bones to align properly.
Done under local anaesthesia in clinic or operating room, this procedure involves a small cut to lengthen the tendon. The final cast is usually applied around three weeks while the tendon heals in the corrected position.
Following casting, children wear special boots connected by a bar to maintain correction. Initially worn 23 hours daily for three months, then during naps and nighttime until age 4-5. Consistent brace use helps reduce the risk of relapse.
Structured exercises complement other treatments by maintaining flexibility and strengthening muscles. Parents learn specific stretching techniques to perform at home between cast changes or after cast removal. Therapy becomes particularly important for children with residual stiffness or muscle weakness.
An alternative involving daily manipulation, stretching, and taping by trained physiotherapists. This intensive approach requires commitment to daily sessions for several months. Outcomes are generally comparable to other conservative methods.
Reserved for severe, resistant, or relapsed cases not responding to conservative treatment. Procedures range from targeted tendon releases to comprehensive reconstruction involving bones, joints, and soft tissues. Modern surgical techniques aim to preserve foot flexibility while achieving proper alignment.
Used selectively to temporarily weaken overactive muscles causing dynamic deformity. This can facilitate stretching and bracing in certain cases. Effects usually last 3-6 months, providing a window for other treatments to work more effectively.
Our Senior Consultant Orthopaedic Surgeon will assess your specific situation and recommend the most suitable treatment approach for you.
Untreated clubfoot leads to progressive disability as the child grows. Walking becomes possible only on the outside edge or top of the foot, causing abnormal pressure and skin breakdown. This altered gait pattern can result in painful calluses, wounds, and potential infections at pressure points.
Long-term consequences include abnormal wear on foot and ankle joints, which may increase the risk of arthritis later in life. The affected leg may also experience muscle underdevelopment, impacting strength and mobility.
Ongoing monitoring and appropriate treatment during growth help support mobility and foot function, emphasising the importance of early and consistent management.
Currently, no definitive prevention methods exist for clubfoot as the exact cause remains unclear. Certain measures may reduce risk based on known associations. Maintaining good prenatal health through regular check-ups allows early detection and planning.
Maternal smoking cessation before and during pregnancy is strongly recommended as smoking doubles clubfoot risk. Adequate folic acid supplementation, while primarily for neural tube defect prevention, supports overall foetal development. Genetic counselling benefits families with clubfoot history to understand recurrence risks.
For subsequent pregnancies after having a child with clubfoot, enhanced ultrasound monitoring can detect the condition early, allowing parents to prepare for immediate postnatal treatment.
With proper treatment starting in infancy, most children with clubfoot achieve good outcomes and participate in all normal activities, including sports. While the affected foot may remain slightly smaller and the calf muscle less developed, these differences rarely affect function. Many professional athletes have competed at professional levels after clubfoot treatment in infancy.
Initial correction through casting typically takes 5-7 weeks with weekly cast changes. Following this, a minor procedure (tenotomy) may be needed, requiring another 3 weeks in a cast. The maintenance phase using boots and bar bracing continues until age 4-5 years, worn during sleep. While this seems lengthy, the intensive treatment occurs in the first few months, with bracing becoming part of the normal bedtime routine. Regular follow-ups continue throughout childhood to monitor for any signs of relapse.
The Ponseti casting method is gentle and not painful for babies. During manipulation and casting, babies may cry due to being held in position or the unfamiliar sensation, but the actual treatment doesn’t cause pain. The Achilles tenotomy is performed under local anaesthesia, ensuring the baby feels no pain during the procedure. Most babies adapt quickly to wearing casts and braces, often sleeping better with the stability they provide. Our team ensures your baby’s comfort throughout treatment.
Clubfoot results from a combination of genetic and environmental factors, though the exact cause remains unknown.These statistics help with family planning decisions, but most subsequent children are unaffected. Genetic counselling can provide personalised risk assessment.
Clubfoot can often be detected during routine prenatal ultrasound scans, typically around 20 weeks of pregnancy. Diagnosis isn’t always possible prenatally, and some cases are only identified at birth. Prenatal detection allows parents to prepare emotionally and practically, including identifying treatment providers and understanding the treatment process. Prenatal diagnosis doesn’t change treatment approaches but enables early intervention planning.
Early signs include the foot turning inward again or difficulty fitting the brace. When caught early, relapse often responds to repeat casting or minor procedures. Our orthopaedic surgeon monitors for relapse signs during regular follow-ups and can quickly intervene if needed. Maintaining prescribed bracing schedules significantly reduces relapse risk.
Clubfoot, while initially concerning for parents, is a highly treatable condition with positive outcomes when addressed early. Modern treatment methods, particularly the Ponseti technique, have transformed clubfoot management, allowing most children to achieve normal foot function without extensive surgery. The key to success lies in early intervention, consistent treatment adherence, and regular monitoring throughout childhood. With proper care from our experienced orthopaedic surgeon, children with clubfoot can look forward to active, unrestricted lives.
Living with clubfoot can be challenging, but you don’t have to face it alone. Our Senior Consultant Orthopaedic Surgeon has considerable experience diagnosing and treating clubfoot using current evidence-based approaches.
A senior consultant orthopaedic surgeon with dual specialisations in Foot & Ankle Surgery and Paediatric Orthopaedics. Backed by his extensive years of training and experience, Dr Chua brings the necessary knowledge and skills to ensure a smooth recovery journey.
Rooted firmly by two fundamental philosophies: “When one’s feet hurt, one hurts all over” and “Children are not little adults”, Dr Chua’s approach to patient care reflects his compassionate care for adults and children.
His active participation in the medical community extends to mentoring, research supervision, and contributions to key professional forums and symposiums, both locally and internationally.
Our friendly clinical staff will assist you with your registration, ensuring an efficient and hassle-free process for you.
During your consultation, we will evaluate your medical history and the pain you are experiencing. You may also ask questions about your condition.
We will likely perform some form of diagnostic imaging (e.g. X-Rays, MRI) to assess your condition accurately.
After imaging, we will review the results of your scans thoroughly, and advise an individualised treatment plan for you.
As you go through your treatment plan, we will follow up with you every step of the way, ensuring that you receive the dedicated care you deserve.
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #05-36, Singapore 329563
Parkway East Medical Centre
319 Joo Chiat Place, #03-06, Singapore 427989