When children are born, adoring parents often joke about their new baby having 10 fingers and 10 toes. In reality, anything different is pretty rare (and not as bad as you might think). More common is seeing feet that point in different directions. Sometimes this is due to the baby being squished in a small space, for example. Other times it is from something that happened during the child’s development or as part of a genetic condition.
Causes & treatment for foot deformities in babies
The two most common foot deformities in newborns are metatarsus adductus and calcaneovalgus. Both are from how the baby’s foot was positioned and molded inside their mother. These conditions usually improve on their own without any treatment, and don’t cause any long-term problems.
Two other deformities, clubfoot and congenital vertical talus, look similar and may occur on one or both sides. However, these are serious congenital disorders that need prompt treatment by an experienced clinician.
Metatarsus adductus is a curve in the middle of the foot that occurs when the feet are folded inward. How crooked the foot looks is less important than whether the foot is flexible and can be straightened out if the examiner gently pushes it into a “normal” position.
Flexible metatarsus adductus usually improves on its own by 6-12 months old. There aren’t studies to show that stretching the foot during feedings or diaper changes helps, but it doesn’t hurt and is reasonable to try.
Feet that are stiff and don’t correct may benefit from casting. The need for surgery is rare, but can be done to straighten the foot if there are problems. Typically, surgery is done only if children have trouble fitting in or tolerating shoes, usually at around 3- to 4-years old.
Children with clubfoot have metatarsus adductus, but the foot is stiff and has other differences such as a high arch. Clubfoot may occur in one or both feet. It is often diagnosed before birth by prenatal ultrasound. If not, the condition is readily noted at birth as a turned-in foot that cannot be simply placed in a normal position. Some clubfeet occur as part of a broader condition, such as spina bifida or arthrogryposis.
The treatment of clubfoot is generally very successful if treated by the Ponseti method starting in the first few weeks after birth. The Ponseti method, which is the international standard of care, involves several casts, generally one week apart, followed by Achilles tenotomy (sectioning of the Achilles tendon) in the doctor’s office. Then there is a brief period of more casting, followed by bracing for several years. It works very well unless families discontinue bracing too soon. When this happens, the clubfoot will return and possibly need surgery.
Calcaneovalgus foot is more or less the opposite of metatarsus adductus. The foot is pushed up and out. When the baby is born, it may be difficult to point the foot down all the way, but this improves without treatment over a couple months. It is not known if stretching helps, but it also probably doesn’t hurt. So, many doctors advise doing some stretching with feeding or diaper changes.
Surgery is usually only needed if the foot was pushed up enough to bend the shin bone backwards (posteromedial bowing) which is rare. The bowing will improve over a couple years on its own, but many children will have a leg length difference that may require surgery later in life. Until then, an insert in the shoe (heel lift) or building up the outside of the shoe helps even out the difference.
Congenital vertical talus
Children with congenital vertical talus also have a foot that bent up and to the outside. Similar to clubfeet, children with congenital vertical talus have a foot that is stiff and won’t correct. It is treated with surgery and casting.