Idiopathic clubfoot is a congenital foot deformity observed at birth with no associated problems or disorders. A small number of clubfoot cases occur secondary to neurogenic problems or are associated with musculoskeletal syndromes.
Currently, idiopathic clubfoot can be corrected with the Ponseti method, which is usually performed during the first months of life.
Relapse (recurrence) of clubfoot deformity usually occurs during childhood. It is often treated when the patient is 4 to 7 years old with minor surgery that includes a tendon transfer to correct muscle imbalance. Sometimes relapse is untreated or missed and persists into adulthood. Additionally, some clubfeet are not treated well initially and present with residual deformity.
Some partially relapsed or residual clubfeet can be well compensated and functional in adolescence and early adulthood. However, with less activity, weight gain, and different shoe wear, the feet can become troublesome and painful.
As an adult, it is important to have a functional foot that is pain-free during daily activity. For many patients, this can be achieved with a proper insole or minor shoe modification. Foot pressure distribution analysis conducted in the gait lab can help to optimize the adjustments.
In other cases, surgery can improve the loading and pressure distribution of the foot and can restore balance. Surgery must address each foot individually, considering that residual or relapsed clubfoot in adults can present with different problems and deformities.
If pain is the major issue and if joints are damaged and arthritic, as often is observed after open surgery, those joints can be fused to stop the pain. Considering that walking in a shoe in a day-to-day environment does not require excessive motion of the joints of the foot, patients usually experience less functional impairment than anticipated after fusion.
In severe cases with complex malalignment and deformity of the foot and in the presence of unstable scars or soft tissue, gradual correction and/or fusion can be safely achieved by using an external fixation frame. This allows the creation of a plantigrade foot that can wear a shoe.