What is cleft foot?
Cleft foot is a rare congenital (meaning your baby was born with it) anomaly in which the foot didn’t develop properly during fetal development. This causes the affected foot to have missing toes, a V-shaped cleft, and other anatomical differences. Cleft foot is very rare, affecting fewer than 1 in 1,000,000 babies.
Surgery can usually improve the foot’s function, especially since the heel, which remains normal, is the area of the foot that’s most needed for walking. So, for both cosmetic and cost reasons, the main issue is: Can your child’s affected foot fit into an off-the-shelf shoe?
Cleft foot occurs by itself (in isolation) along with a similar cleft of the hand, called split hand-split foot malformation (SHFM) or ectrodactyly. Most affected children — except those with very mild cases — need one or more surgeries, usually starting at around 1 or 2 years of age, when a child can tolerate surgery and anesthesia well.
Surgery’s first goal is to improve the foot’s function. The second goal is to improve the foot’s shape and appearance, preferably before the child becomes aware that their foot looks different from those of other children.
Surgically reshaping the foot increases the chances of the child being able to wear off-the-shelf shoes, instead of costly custom-made shoes. When planning surgery, the surgeon must consider not just the bones of the foot, but also soft tissue, such as ligaments and nerves.
Cleft Foot | Symptoms & Causes
What are the signs and symptoms of cleft foot?
Signs of cleft foot are visible at birth, and increasingly, on prenatal ultrasound. The baby’s foot has missing toes, a V-shaped cleft, and possibly other anomalies.
In the majority of children who have it, a cleft foot may be an isolated occurrence, affecting only her foot. But your doctor will also check for any associated deformities or syndromes.
If a fetal ultrasound reveals that your baby has a cleft foot, you’ll be referred to an orthopedic specialist, who will help you plan for your child’s care after she’s born. If you haven’t learned during your pregnancy that your child has a foot problem, the cleft foot will be visible when your baby is born, and you will be referred to a lower limb specialist.
What causes cleft foot?
Cleft foot is generally understood to have a genetic cause. Cleft foot can occur by itself, with cleft hand (ectrodactyly, also called split hand-split foot malformation), or as part of a genetic syndrome.
Cleft Foot | Diagnosis & Treatments
How is cleft foot diagnosed?
Cleft foot develops during fetal development — when the bones of the foot are forming. The condition can sometimes be detected on a routine prenatal ultrasound. After the baby is born, the deformity is visible.
Details of the diagnosis are usually confirmed through a physical exam and x-rays. Your child’s doctor will closely evaluate every anatomic structure of your child’s foot, determining what is present or absent, normal or abnormal. The doctor will carefully assess the specifics of the soft tissue of your child’s foot, including ligaments, blood vessels, nerves, and muscles.
If your child is diagnosed with a cleft foot, their doctor will check for other associated deformities or syndromes.
How is cleft foot treated?
Not all children need surgery for a cleft foot — it may not be necessary if your child has good use of their foot and the deformity is not too severe. However, if your child's foot has significant functional or cosmetic problems, their doctor may recommend surgery.
Surgeons will perform surgery early in a child's life if the cleft foot's deformities are progressive (will worsen over time) — such as syndactyly (joining) between the toes, or transverse bones between the digits. If the cleft foot doesn't have progressive deformities, surgery can take place when the child is 1 or 2 years old.
If surgery is needed to repair a cleft foot, surgeons have many different approaches available. The timing and sequence of procedures will vary from child to child, but in general, the first procedure is usually done when, or after, a child is 1 or 2 years old — old enough to tolerate anesthesia and surgery well.
In general, the goals of surgery are:
- close the cleft and make sure your child can use his foot effectively
- reorganize the skin and soft tissue
- stabilize or transfer the bones of the foot
Caring for your child after surgery and into childhood
For about four to six weeks after surgery, your baby will be in a cast stabilized by pins. After this period, the doctor can remove the cast and pins in the office setting without sedation.
For several weeks, your child will wear a splint to bed to maintain alignment and help with scar reduction. She'll receive occupational therapy until she achieves supple active motion and developmentally appropriate use of the foot, during which time the doctor will monitor progress monthly. The doctor will then follow them yearly until they stops growing (reaches skeletal maturity).
What is the long-term outlook?
The quality of the reconstruction of your child's foot depends to a large extent on how severe the original malformation was. As a result of surgery, you can expect that she will have a functional foot and an improvement in the foot's appearance. The alignment of the toes should also improve.
As your child grows, some gaps and deformities that were reconstructed by their original surgery can recur. In these cases, additional procedures may be needed.
How we care for cleft foot
The Orthopedic Center's Lower Extremity Program offers comprehensive assessment, diagnosis, surgical, and non-surgical treatment of infants, children, and teens with complex disorders of the lower extremities, including cleft foot.
With more than 5,000 pediatric visits per year, our multidisciplinary team of fellowship-trained, board-certified pediatric orthopedic surgeons is one of the most experienced in the country.