ESCANABA — Walking is a complex act, but one to which we give little thought. Step after step, day after day, it’s a recurring act. Five to ten thousand steps are taken on an average day by most Americans. This complexity requires good working parts, meaning proper anatomy is necessary. When it isn’t present, something will be stressed, some joint or tendon, a bone or ligament. Sometimes we are born with abnormal anatomy, the case in a clubfoot deformity.

This is a relatively common condition, occurring in one out of a thousand births. It can be associated with certain neurological diseases but generally is found as an isolated abnormality. Details of the condition have been discussed in these very pages some months ago but may be summarized as resulting in a foot which is turned inward and up. As one should expect with human variability, this deformity is seen with numerous variations.

Our methods of treatment have changed over the years, and have improved greatly, but remain less than optimal. Many of those born with a clubfoot deformity have had a conservative approach to care involving manipulation and serial casting known as the Ponseti method. This has become the treatment of choice with surgery utilized for only the most severe cases.

Operations for clubfoot used to be more commonly performed. Reliably, this resulted in excessive scarring and stiffness, with pain and disability the result. Experience has shown us surgery results in a poorly functioning extremity, and one that is still not properly shaped, i.e. possessing sufficiently normal anatomy. As has been reported numerous times in these pages, when it comes to the feet, function follows form, meaning a person’s biomechanics are determined by how these structures are shaped (especially bone).

The Ponseti method, although producing no significant scar tissue, does not correct the structural abnormalities that are part of a clubfoot deformity, what is technically referred to as talipes equinovarus. The bones line up better relative to each other, as well as the ankle and leg, but they are still not normally configured. And this means altered function.

Although quite logical, our studies have ably demonstrated anyone with a foot shaped differently will work differently. This includes its ability to support the body in stance, propelling us forward in ambulation, and able to adapt to changing support surfaces keeping the body upright. The take home message is someone with a clubfoot deformity, regardless of the form of medical intervention, even those with a milder form that had no treatment, all will have pathologic biomechanics.

The capacity of the individual to walk is usually altered. Those afflicted are often unable to ambulate with a proper heel-to-toe gait style, making stairs more difficult, walking on uneven ground problematic. All these issues will vary depending on the type and severity of the deformity and how all the many structures involved are affected.

Numerous other parts may be involved in a clubfoot deformity. Even the knee, with an abnormal reverse bend developing over time, whereby the knee goes past straight. Weakness of the calf muscles may ensue which predictably alters gait. And that is never a good thing. If some change in gait occurs for a limited period of time, no lower extremity structure will be stressed sufficiently to cause pain. If the variation from normal structure and function occurs for long enough, repetition will lead to problems.

Certainly, those with more extensive deformity will generally have poorer quality of life measures as an adult, even with appropriate interventions. These individuals often must endure multiple reconstructive procedures in an attempt to provide a stable, shoe-able foot. But it isn’t uncommon for a child’s foot to be only mildly altered and no treatment is felt necessary.

Still, it is rare that “normal” is achieved. Altered biomechanical functioning is a product of most any clubfoot deformity. When the foot is sufficiently abnormal, bracing of some sort is often needed and can be beneficial in both pain relief and activity levels. One type is used by an infant while a very different type is used by the adult who is experiencing chronic pain secondary to their impaired mechanics.

Because of advances in chemistry and materials science, there are now numerous options for foot and ankle supports and braces. Gone are the days of bulky, immobilizing, heavy braces, with some newer designs occupying no room inside the shoe whatsoever. And with an improved understanding of biomechanics and body motion, these can even aid the person’s stance and walking abilities.

Not everyone needs something supporting the ankle joint, depending on the alignment and functioning of the individual. Even in the face of deformity, both of these issues can be improved when the supporting surface is brought up to the feet, to better maintain the alignment of the body. In a way, this is what a custom foot support, aka foot orthotics, can do for the human body. When fashioned correctly, they can improve biomechanical function and the complex second-to-second changes that are part of healthy gait. Those with a clubfoot usually benefit greatly from a custom, in-shoe support that decreases stress to those tissues producing pain.

Talipes equinovarus, what the public refers to as a clubfoot, is a complex congenital deformity, too often resulting in impaired anatomy and function. Depending on a plethora of variables, significant pain and limitations may develop as an older adult. Many therapies for pain relief exist, although too many of our drugs carry a laundry list of side effects. Orthotics require only that you put your shoes on. If you or a family member is suffering from the residual complications of a pediatric clubfoot deformity, don’t assume there is nothing that can be done. Life is better when you can do more…especially without pain!

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.