Twisted limb syndrome in children causes and complete treatment

Many parents notice after birth that their baby has a deformity in the foot, which may be a sign of clubfoot (Congenital Talipes Equinovarus). Although this condition is relatively uncommon, it’s very important because it can affect the child’s walking and normal growth if not treated early.In this Dalily Medical guide, we’ll explore the main causes of clubfoot, its symptoms, different types, stages, and how it’s diagnosed. We’ll also cover treatment methods such as the Ponseti bracing technique and surgery, along with practical tips for parents to follow up with their child’s progress.This guide will help you understand every step of the treatment journey, ensuring your child can enjoy a healthy growth and a normal life.

What is Clubfoot in Children?

Clubfoot (Congenital Talipes Equinovarus) is a congenital deformity that causes a baby’s foot to turn downward or inward.
If left untreated, it can affect the child’s walking and normal movement.
Early diagnosis and prompt treatment increase the chances of success and reduce the risk of future complications.

Causes of Clubfoot in Children

In most cases, the exact cause is unknown, but it is usually congenital. Sometimes it may be linked to:

Genetic factors: family history of clubfoot.
Neurological or muscular problems that affect foot movement.
Other congenital syndromes that may occur alongside the condition.

Symptoms of Clubfoot in Children

The foot appears twisted downward or inward.
Tight ankle with shortened tendons, which limits movement.
In severe cases, the child may develop an abnormal walking pattern once they start walking.
Immediate medical attention may be required to prevent long-term problems.

Can Clubfoot Be Diagnosed Before Birth?

Yes, clubfoot can be detected during pregnancy using ultrasound (usually between weeks 18–22).
Early diagnosis helps parents and doctors prepare a treatment plan right after birth.

Types of Clubfoot in Children

Congenital Clubfoot: the most common type, present at birth.
Syndromic Clubfoot: associated with other congenital anomalies.
Acquired (Secondary) Clubfoot: rare, develops after birth due to other problems.
Familial/Genetic Clubfoot: occurs in some families with a hereditary link.

Treatment Options for Clubfoot

Ponseti Method (bracing and casting): the primary and most successful treatment.
Surgery: for severe cases or when bracing doesn’t work.
Exercises: to improve flexibility, strengthen muscles, and prevent relapse.
Supportive medications: for pain relief or muscle relaxation if needed.

Risks of Untreated Clubfoot

Abnormal walking pattern → may affect knees, hips, and spine.
Permanent foot deformity and difficulty wearing normal shoes.
Chronic pain and weakness in muscles and bones.
Psychological and social impact due to the visible deformity.

Can a Child Walk Normally After Treatment?

Yes, most children are able to walk normally with early treatment and regular follow-up.

Does the Child Need Ongoing Follow-up?

Yes, regular follow-up is essential to monitor foot growth, prevent relapse, strengthen muscles, and maintain normal movement.

Summary

Clubfoot (Congenital Talipes Equinovarus) is a congenital condition where the baby’s foot is twisted downward or inward.
While the main cause is usually congenital, factors like genetics or associated syndromes may contribute.
Early diagnosis after birth is key to successful treatment and preventing long-term complications.

Causes of Clubfoot in Children

1️⃣ Genetic causes

Family history increases the likelihood of the condition.
Certain genetic mutations may affect bone and tendon development in the foot.

2️⃣ Factors during pregnancy

Fetal position in the womb: pressure on the feet may increase the risk.
Low amniotic fluid: reduced movement space for the fetus can affect foot positioning.

3️⃣ Problems with tissues and tendons

Abnormalities in muscles, ligaments, or tendons can cause the foot to twist inward or downward.
A short Achilles tendon makes it difficult to fully straighten the foot.

4️⃣ Pregnancy and delivery-related factors

Twins or multiple pregnancies: higher pressure inside the womb.
Older mothers or smokers → higher risk of congenital deformities.
Maternal conditions such as diabetes or obesity may also increase the risk.

5️⃣ Rare causes

Linked to neurological or muscular disorders in the child.
Can appear as part of broader congenital syndromes affecting the spine or limbs.

Symptoms of Clubfoot in Children

1️⃣ Foot appearance

Foot twisted downward or inward.
Heel raised and toes pointing toward the ground or toward each other.
Foot may appear smaller than normal.
Visible deformity from both front and back views.

2️⃣ Foot movement

Difficulty moving or straightening the foot due to tight tendons/ligaments.

3️⃣ Leg/foot differences

Affected foot may be shorter or thinner.
Can affect one foot (unilateral) or both (bilateral).

4️⃣ Walking issues (after walking age)

Child may walk on toes or the side of the foot.
Abnormal gait can later affect knees, hips, or spine.

5️⃣ Signs of tight muscles and tendons

Short, tight Achilles tendon → prevents full foot extension.
Tight ligaments and muscles around the foot keep it fixed in a twisted position.

⚠️ Note:
Symptoms are usually visible from birth.
Early diagnosis and treatment give the best outcome.

Types of Clubfoot

1️⃣ Congenital clubfoot

Most common form, present at birth.
Caused by bone, tendon, or ligament abnormalities.
May affect one or both feet.

2️⃣ Syndromic clubfoot

Associated with other congenital syndromes, e.g. Down syndrome or Arnold–Chiari malformation.
Usually more complex and harder to treat.

3️⃣ Acquired (secondary) clubfoot

Develops after birth due to neurological issues like cerebral palsy, nerve injury, or trauma.
Less common.

4️⃣ Familial/genetic clubfoot

Runs in families, with repeated cases across generations.

Complications if Untreated

1️⃣ Walking and mobility problems

Child may walk on toes or foot side.
Abnormal gait leads to knee, hip, and spinal problems.
Poor balance and difficulty in sports or daily activities.

2️⃣ Permanent deformity

Persistent twisted or misshaped foot.
Difficulty wearing normal shoes → may require custom footwear.

3️⃣ Chronic pain

Continuous muscle/tendon tension causes pain during walking or standing.
May also cause swelling or cramps.

4️⃣ Weak muscles and bones

Limited natural movement weakens leg muscles.
Abnormal bone development can affect leg length or stability.

5️⃣ Psychological and social impact

Visible deformity may lower self-confidence.
Difficulty joining peers in play or sports → feelings of isolation.

Stages of Clubfoot

1- Mild stage

Slight inward/downward tilt.
Foot movement limited but possible.
Child can walk almost normally if treated early.
Treatment: Ponseti method or simple daily exercises.

2- Moderate stage

Clear deformity, noticeable tendon tightness.
Difficulty wearing regular shoes.
Abnormal gait present.
Treatment: prolonged Ponseti method + braces, sometimes injections to relieve tension.

3- Severe/complex stage

Foot is strongly twisted and stiff.
Walking on toes/foot side.
Severe tendon/muscle tightness, possible pain or swelling.
Treatment: extended Ponseti method + surgery.

⚠️ Note: Early intervention improves results and prevents recurrence.

Diagnosis

1- After birth

Physical exam of foot appearance and movement.
Compare affected and unaffected foot.

2- Before birth (Ultrasound)

Detectable at 18–22 weeks of pregnancy.

3- Tendon/muscle evaluation

Checking Achilles tendon tightness and calf muscle strength.

4- X-rays (if needed)

To assess bone positioning in severe cases.

5- Excluding other conditions

Rule out neurological causes such as cerebral palsy.

Risks of Untreated Clubfoot

Abnormal gait leading to knee/hip/spinal issues.
Permanent deformity and shoe difficulties.
Chronic pain and swelling.
Muscle/bone weakness and growth issues.
Psychological/social challenges.

Treatment with Medication

Not a primary treatment.
Used only as supportive care.

1- Pain/anti-inflammatory drugs: paracetamol, ibuprofen.
2- Muscle relaxants (short-term use): for severe tendon tightness.
3- Nutritional support: Vitamin D, calcium for bone growth.

Treatment with Surgery

Used as a last resort if conservative methods fail.

1- When is surgery needed?

Severe/complex deformity.
Ponseti method unsuccessful.
Strong tendon contracture preventing movement.
Gait severely affected.

2- Types of surgery

Tendon release: especially Achilles tendon.
Osteotomy: bone realignment.
Soft tissue release: freeing ligaments/muscles around the ankle.

3- Post-surgery care

Casts or braces.
Physiotherapy to strengthen muscles.
Regular check-ups to avoid relapse.

Treatment with Exercises

Important both after birth and after Ponseti correction.

1- Foot stretching: gentle side-to-side and forward-backward movements.
2- Achilles tendon stretches: improve flexibility.
3- Muscle strengthening: guided physiotherapy to prevent weakness.
4- Balance/walking exercises: standing and walking on safe surfaces.
5- Relapse prevention: daily stretches to maintain correction.

⚠️ Must be supervised by a doctor or physiotherapist.

Practical Tips for Parents

1- Stick to the treatment plan. Don’t stop early.
2- Keep regular follow-up visits.
3- Do daily exercises at home.
4- Be patient and consistent — treatment takes time.
5- Give emotional support — encourage play and participation.
6- Care for casts/braces: keep them clean and dry, and check for redness/swelling.