What Causes Clubfoot In Adults And How Its Treated?

Clubfoot in adults is almost always the same condition the person was born with, not a new problem that developed later. It is a congenital foot deformity present at birth, and the term “adult clubfoot” usually refers to an untreated or partially treated case that has carried into adulthood. It is not a disease that suddenly appears in grown adults. Some adults do develop a foot that turns inward from nerve damage or injury, but that is a different issue with different causes.

The treatment picture in adults is also different from infancy. When clubfoot is corrected in babies, the foot is still growing and responds well to gentle stretching and casting. In adults, the bones are mature and the tissues are set, so correction usually means surgery, and the goal shifts from reshaping the foot to improving function and reducing pain.

What Causes Clubfoot In Adults And How Its Treated?

Clubfoot is present at birth in nearly every case, so the cause in an adult is the same cause that was there in infancy. The exact reason a baby develops clubfoot is not fully understood, but it is not caused by anything the mother did or did not do during pregnancy.

What is known is that clubfoot is a structural problem. The tendons on the inside of the ankle and foot are too tight, and the tendons on the outside are too loose or stretched. The bones of the foot are also shaped and positioned abnormally. This combination pulls the foot inward and downward. In many cases the heel cord, the strong tendon at the back of the ankle, is shortened.

Researchers have identified several factors that raise the chance a baby is born with clubfoot:

• Family history. A person with a close relative who had clubfoot has a higher chance of having it themselves.
• Being male. Clubfoot is more common in boys than girls.
• Having a condition that affects the nerves or muscles, such as spina bifida or cerebral palsy. These are sometimes called syndromic or neuromuscular clubfoot, and they tend to be stiffer and harder to treat.
• Certain genetic syndromes and chromosomal conditions.

Most clubfoot cases, though, happen in babies with no family history and no other health condition. These are called idiopathic clubfoot, and they make up the large majority of cases.

In adults, what looks like new clubfoot can occasionally come from something else. Nerve damage, a spinal cord problem, or a severe injury can cause a foot to gradually turn inward over time. This is not the same condition as congenital clubfoot. It is a deformity caused by muscle imbalance, and it needs its own evaluation. If an adult foot is turning inward and the person was not born with clubfoot, that is a reason to see a doctor rather than assume it is clubfoot.

Why Do Some Adults Still Have Clubfoot?

Adults still have clubfoot for one of two reasons: they were never treated, or they were treated and the correction did not hold.

In parts of the world where early medical care is limited, many children born with clubfoot never receive treatment. They grow up walking on the side or top of the foot. Over decades, this changes how the bones and joints wear, and it often leads to pain, calluses, and difficulty finding shoes that fit.

In places with good access to care, most clubfoot is treated in infancy. But treatment does not always produce a perfect result. Some feet relapse, meaning they drift back toward the inward position. Relapse can happen years after treatment. If a relapse is not caught and corrected during childhood, the person can reach adulthood with a foot that is partly or fully turned in again.

There is also a group of adults who had treatment as children that left the foot functional but not normal-looking. They may have a smaller foot, a stiff ankle, or a foot that turns in slightly. Many of these adults function well and have no pain. Others develop problems later as the joints wear unevenly.

How Is Clubfoot In Adults Treated?

Surgery is the main treatment for clubfoot that is still present in adulthood. The gentle casting method used in babies does not work once the bones have finished growing, because the foot can no longer be gradually reshaped.

The type of surgery depends on how stiff the foot is, how much pain the person has, and how much function is lost. Options include:

• Soft tissue release. The surgeon lengthens tight tendons and releases tight ligaments to bring the foot into a better position. This is more likely to be an option in a foot that is still somewhat flexible.
• Bone surgery (osteotomy). The surgeon cuts and repositions bones to correct the alignment. This is used when the deformity is fixed and cannot be moved by releasing soft tissue alone.
• Joint fusion (arthrodesis). In a severely deformed or painful foot, the surgeon may fuse some joints to hold the foot in a stable, functional position. Fusion removes motion in those joints, so it is a trade-off.
• External fixation. In complex cases, a frame outside the leg can be used to gradually move the foot into position over weeks.

Not every adult with clubfoot needs surgery. Some adults have a foot that is deformed but painless and functional. In those cases, doing nothing may be reasonable, and the risks of surgery may not be worth it. This is a decision that should be made with an orthopedic surgeon who has experience with this condition.

Recovery from adult clubfoot surgery is long. It often involves a period of not putting weight on the foot, followed by physical therapy to rebuild strength and movement. Full recovery can take months. It is also important to know that surgery in adults is generally done to improve function and reduce pain, not to produce a perfectly normal-looking foot. Setting realistic expectations matters.

What Problems Does Untreated Clubfoot Cause In Adults?

An untreated or relapsed clubfoot can cause a range of problems, and how severe they are varies widely from person to person.

Common issues include:

• Pain in the foot, ankle, knee, hip, or lower back. The foot is the base the whole body stands on, so a deformity there can change how a person walks and put stress on joints higher up.
• Calluses, sores, and skin problems from walking on parts of the foot not meant to bear weight.
• Difficulty finding shoes that fit and are comfortable.
• Arthritis in the affected joints, which can develop earlier than usual because of abnormal wear.
• Reduced walking distance and balance problems.

One detail that surprises many people: the amount of deformity does not always match the amount of pain. Some adults with a visibly turned foot have little pain, while others with a milder deformity have significant pain. The reasons for this are not fully understood, which is why treatment decisions are made case by case rather than by how the foot looks alone.

Can Clubfoot Come Back After Treatment?

Yes. Relapse is a recognized part of clubfoot, and it can happen even after successful early treatment. Relapse is more common in certain situations, including when the original deformity was severe, when the family did not follow through with bracing after casting, and in neuromuscular cases.

This is why children treated for clubfoot are usually followed for years, often until they stop growing. Catching a relapse early makes it easier to correct. When a relapse is not caught, it can persist into adulthood.

For adults who had clubfoot treated as a child and now notice the foot turning back in, or new pain, that is worth an evaluation. It does not automatically mean another surgery is needed, but it should be looked at by someone familiar with the condition.

What Is the Outlook for Adults With Clubfoot?

Many adults with clubfoot live active, functional lives. The condition does not shorten life and does not affect the heart, lungs, or other organs. It is a mechanical problem in the foot and ankle.

The outlook depends on how severe the deformity is, how much pain it causes, and whether treatment helps. Adults who have surgery often see improvement in pain and walking ability, but results vary, and no operation restores a foot to completely normal. Adults who do not have surgery and function well may stay stable for many years.

Physical therapy, proper footwear, and in some cases custom orthotics can help manage symptoms. These do not correct the deformity, but they can make walking more comfortable. Anyone with clubfoot who is considering treatment should get a full evaluation from an orthopedic specialist, because the right choice depends heavily on the individual foot.