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Few moments are harder than being told, minutes after delivery, that something is different about your baby. If that something is clubfoot — one or both feet turned inward and downward — here is what the doctor should tell you next, and what this page will keep repeating: clubfoot is one of the most successfully treated birth conditions in all of medicine. With treatment that involves no major surgery, more than 95% of these children grow up to walk, run, and play sports — indistinguishable from their friends. Some of the world’s most famous footballers and Olympic athletes were born with clubfoot.
The children who struggle with clubfoot are, almost without exception, the children who were never treated — often because their families were told nothing could be done, or were made to feel the condition was somehow their fault. Neither is true. At Kids Care International Hospital in Rawalpindi, our pediatric orthopedics team treats clubfoot from the first weeks of life — and, importantly, in older children too.
Appendicitis happens when the appendix becomes blocked, allowing germs inside it to multiply. The appendix swells, becomes infected, and — if not treated in time — can burst and spread infection through the abdomen. This is why appendicitis is always treated urgently.
Babies are born with clubfoot
Corrected without major surgery (Ponseti method)
Ideal age to begin treatment — but it is never too late
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Clubfoot — the medical name is congenital talipes equinovarus (CTEV) — is a condition a baby is born with, in which the foot points downward and twists inward, so the sole faces sideways or even upward. The tendons on the inside and back of the foot are shorter and tighter than normal, pulling the foot into this position. It can affect one foot or both; in about half of children, both feet are involved.
Two things surprise most parents:
It does not hurt the baby. A newborn with clubfoot feeds, sleeps, kicks, and develops exactly like any other baby. The problem only becomes painful years later, if the foot is left uncorrected and the child begins walking on its side or top.
The foot is not “deformed” — it is held in the wrong position. The bones, muscles, and skin are all there. Treatment works by gradually guiding the foot into the correct position while the baby’s tissues are still soft and stretchable — which is why starting early makes treatment so smooth
Not every inward-turned newborn foot is clubfoot, and this distinction matters:
Positional foot (womb-cramping) | True (structural) clubfoot | |
Cause | Foot was pressed into position in the womb | Tendons and joints developed short and tight |
Flexibility | Soft — can be gently moved to a | Stiff — cannot be fully straightened by hand |
Treatment | Usually none, or simple stretching; | Needs proper treatment (casting + bracing) |
A pediatric orthopedic specialist can tell the difference in a single examination. If your newborn’s foot looks turned, don’t guess — have it assessed early, because true clubfoot treated in the first weeks is the easiest treatment there is.
In most children, no single cause is ever found. Clubfoot develops early in pregnancy through a mix of genetic and environmental factors. Known risk factors include:
Just as important is what does not cause clubfoot, because mothers are so often unfairly blamed:
Clubfoot begins forming around the 9th–14th week of pregnancy, long before anyone could know or act. No parent causes it
Many families today learn about clubfoot before birth, during the routine anomaly ultrasound around 20 weeks of pregnancy. This is genuinely good news when it happens: it gives parents time to understand the condition, meet the treating team, and plan care calmly — rather than absorbing everything in the delivery room. If clubfoot is seen on your pregnancy scan, you can consult our pediatric orthopedic team at KCIH before your baby arrives.
After birth, diagnosis is made by physical examination alone — the appearance and stiffness of the foot tell the specialist what they need to know. X-rays are rarely required in newborns. The examination also grades how severe the clubfoot is, which helps predict how many casts will be needed.
The worldwide gold standard is the Ponseti method — a gentle, largely non-surgical technique that has replaced the major foot operations of past decades. It has three phases, and understanding all three from day one is the key to success.
Once a week, the specialist gently stretches the baby’s foot a little further toward the correct position and holds the improvement with a plaster cast from toes to thigh. Each week, the cast comes off, the foot has moved — visibly — and a new cast continues the journey. Most feet are corrected in 5 to 8 casts. Babies tolerate the casts remarkably well; they are not in pain, and feeding and sleeping continue normally.
In most children (around 8–9 out of 10), the tight Achilles tendon at the back of the heel needs one small assist: a tenotomy — a tiny puncture procedure done under local anesthesia that releases the tendon so the foot can come up fully. It takes minutes, needs no stitches, and the tendon heals back at its new, correct length inside the final cast, worn for about three weeks. This is not the “major surgery” parents fear — there is no cutting open of the foot, no metal, no hospital stay.
After the final cast, the correction is complete — but a corrected clubfoot wants to turn back. Preventing that is the job of the foot abduction brace: two small boots connected by a bar, worn:
23 hours a day for the first 3 months
Then during nights and naps until around age 4 to 5
Read that last line again, because it is the single most important sentence on this page. Nearly every clubfoot that “comes back” comes back for one reason: the brace was stopped too early. The foot looks perfect, the child is walking, relatives say the brace is no longer needed — and quietly, over months, the foot begins to turn again. Families who complete the bracing years almost always keep the correction for life. The brace does not delay walking, standing, or development; children crawl, stand, and cruise while wearing it at night without difficulty.
This question matters enormously in Pakistan, where many children with clubfoot arrive at clinics at age 2, 5, or even 10 — because their families were told nothing could be done, or treatment was started and abandoned.
The honest answer: it is harder, but it is not too late. The Ponseti method works well beyond infancy — walking-age and older children can still be treated with a longer series of casts, tenotomy, and bracing. Some older or previously operated feet need an additional surgical procedure to complete the correction. The path is longer than it would have been at three weeks of age, but the destination — a flat-standing, shoe-wearing, pain-free foot — is still reachable for the great majority of children.
If your child’s clubfoot was never treated, or treatment was left incomplete, bring them for assessment. No specialist at KCIH will ask why you didn’t come sooner; we will simply start from where the foot is today.
An untreated clubfoot does not correct itself. The child learns to walk — children are extraordinarily adaptable — but on the outside edge or top of the foot, where skin was never meant to bear weight. Over the years this causes:
Every one of these outcomes is preventable. That is what makes untreated clubfoot uniquely tragic — and treated clubfoot uniquely rewarding.
A child whose clubfoot was fully treated — casts completed, tenotomy done, brace worn to the end — runs, climbs, plays cricket and football, and wears ordinary shoes. The treated foot may be slightly smaller or the calf slightly slimmer than the other side; this is normal, rarely noticeable, and does not affect function. Follow-up visits continue through the growing years so any early sign of relapse is caught while it is still easy to fix.
Your child’s clubfoot will one day be a story you tell them about their first year — not a condition they live with.
No. A baby born with clubfoot feels no pain from the condition — they feed, sleep, kick, and develop completely normally. Clubfoot only becomes painful years later if it is never corrected and the child walks on the side or top of the foot. Treatment in infancy is also essentially painless; babies tolerate the weekly casts very well.
Largely, yes — that is the essence of the Ponseti method, today’s worldwide gold standard. The foot is corrected with gentle weekly stretching and casts. Most babies also need a tenotomy: a minutes-long release of the tight heel cord through a tiny puncture under local anesthesia — not an open operation. Major reconstructive surgery is reserved for a small minority of resistant or late-treated feet.
Ideally within the first 2–3 weeks of life, when the baby’s tissues are softest and correction is quickest. However, the Ponseti method also works in older babies and children — so if your child is months or even years old, treatment is still very much possible. The right time to start is simply as soon as you can.
No. Clubfoot forms between roughly the 9th and 14th week of pregnancy through genetic and developmental factors no parent can control or prevent. It is not caused by the mother’s diet, work, movements, an ultrasound, or any belief-based explanation. Blaming the mother is both wrong and harmful — this condition is nobody’s fault.
Most feet are corrected in 5 to 8 weekly casts, though stiffer feet may need a few more. Each cast holds the gentle correction achieved that week, and parents can usually see the foot’s position improving from one cast to the next — which makes this a uniquely encouraging treatment to go through.
No. The brace is worn mainly during sleep after the first three months, so it does not interfere with crawling, standing, or walking. Children treated for clubfoot start walking at the normal age, and once treatment is complete, they run and play sports like any other child.
It can — which is exactly why the brace and follow-up visits exist. Relapse is almost always linked to stopping the brace before age 4–5, and when caught early at follow-up, it is usually fixed with a short repeat course of casting. A fully treated, fully braced clubfoot that reaches age 5 corrected almost always stays corrected for life.
Yes. Fully treated children participate in every activity — football, cricket, running, everything. Several world-class athletes were born with clubfoot and had it corrected in infancy. The treated foot may be a shoe size smaller with a slightly slimmer calf, which rarely bothers anyone and does not limit function.
At Kids Care International Hospital (KCIH) Rawalpindi, clubfoot is treated by our pediatric orthopedic Dr. Hussain Wahab using the Ponseti method — weekly casting, tenotomy, and bracing with long-term follow-up, all under one roof at the twin cities’ dedicated children’s hospital. Antenatal counseling is also available if clubfoot was seen on your pregnancy ultrasound.
