Clubfoot is a structural deformity of the foot present at birth. It is characterized by four main
components, remembered by the acronym CAVE

• Cavus: High arch of the foot
• Adduction: Forefoot turned inward
• Varus: Heel turned inward
• Equinus: Foot pointing downward (plantarflexed)

That type of positioning makes it impossible or challenging for the child to place the sole flat on
the ground. In many instances, the reason for clubfoot remains unidentified. Some cases are
associated with other disorders most commonly Spina Bifida, Cerebral Palsy and
intrauterine positioning. Clubfoot is usually diagnosed at birth through clinical examination,
and in many cases, it can be identified before birth through ultrasound as early as 20 weeks.

After birth examinations may include:

• Physical assessment of foot deformity
• X-rays to check bone alignment

Physiotherapy plays a very important role in the management of clubfoot—before, during, and
after corrective treatments such as the Ponseti method or surgery. The Ponseti method consists
of 2 equally important phases:

• Casting phase
• Maintenance phase.

Casting Phase: Which consists of Manipulation, Casting and Tenotomy(Surgical
procedure to release tendon)

Maintenance Phase: Which is the use of Foot Abduction Brace to prevent relapse..

The main physiotherapy goals are to improve foot alignment, strength, mobility, and prevent
recurrence. In early interventions for mild cases some techniques are used such as Gentle passive
stretching of tight structures (especially calf and medial foot), Mobilization, Taping and Parent
education on positioning and handling.

Common physiotherapy tools that are used include:

• Passive ROM exercises (dorsiflexion, abduction, eversion)
• Resistance bands for strengthening
• Proprioceptive and balance boards
• Kinesiology taping
• Functional play-based therapy (e.g., kicking, climbing)

Essential Physiotherapy Considerations:

• Start treatment as early as possible in 1st week after birth
• Be consistent and follow up regularly
• Educate and involve caregivers at every stage
• Monitor for signs of recurrence well into early childhood.