What is clubfoot? Clubfoot is a congenital (present at birth) foot disorder. It involves the bones, muscles, musculature, and blood vessels, and can occur unilaterally or bilaterally. The foot has a short and wide appearance, with a downward-facing heel and an inward-turning forefoot. The heel is tense, the heel is narrowed, and the calf muscles are thinner than normal. The prevalence of clubfoot is 1/1000, and is twice as common in males as in females. 50% of children with clubfoot have bilateral involvement. What causes clubfoot? Clubfoot is thought to be a multifactorial genetic disorder. This means that there are multiple factors that contribute to the development of clubfoot at birth, both genetic and environmental. In multifactorial disorders one sex is often more likely to be affected than the other. There appears to be an expression threshold that indicates that one sex is more likely to show the abnormality than the other. For example, clubfoot is twice as common in males as in females. Once a child is born with clubfoot, the prevalence of clubfoot in another boy or girl is 4%. In other words there is a 96% chance that another child will not develop clubfoot. What are the risk factors for clubfoot? Risk factors include: Family history of clubfoot Fetal position in utero Increased chance of clubfoot in children with neuromuscular pathologies such as cerebral palsy or spina bifida Low amniotic fluid during pregnancy (a decrease in the amount of amniotic fluid around the fetus in the uterus) Children born with clubfoot are also at increased risk of developing developmental congenital dislocation of the hip (DDH), a condition in which the child’s femoral head slips out of the acetabulum because it is too shallow. How is clubfoot diagnosed? Horseshoe foot can be detected through a physical examination. During the examination the doctor obtains a medical history before and after birth and asks if any other family members also have clubfoot. If the child is an older infant or child, the doctor will ask other questions that may be related to the neuromuscular disorder. Developmental delays may require further follow-up to detect underlying disorders.