Newborn Foot Problems

Alvin Gore, MD, DPM

All new parents marvel at the look of their babies' tiny feet. Despite their small size, however, these two feet are very complex medical and anatomical structures. Lots of small bones, some hardened, some still as cartilage, along with multiple muscles, ligaments and tendons make up these feet. Even though the majority of newborns are born with completely normal feet, various foot anomalies happen more often then we frequently suspect. Each newborn is examined in the nursery, and a foot examination is a part of that complete exam. This article will briefly discuss the most common abnormalities of a newborn's foot, and the recommendations as to their treatment.

Turned-in foot (or Metatarsus Adductus, MTA) is one of the most common types of foot deformities, occurring in about two out of 1,000 births. This foot looks bent inward in the middle with the toes pointing in, creating a C-shaped outer foot border. There might be a gap between the big and the 2nd toe. A simple test for this particular anomaly is called the "V"-finger test. It is performed by placing the sole of the foot between the index and middle fingers. If the outer part of the foot does not align with the middle finger, while observed from the sole of the foot, MTA might be present.

Treatment is based on the severity of this condition and can range from observation and foot stretching exercises to repetitive cast applications. The majority of these children do very well with a complete resolution of the problem; however, in severe cases kids are more likely to develop future foot problems, such as bunions, hammertoes, etc.

Clubfoot is another deformity where the foot points in, but as a whole. This condition is more common in first-borns, especially boys, and is more common in Hispanics. There are about one to two cases of clubfoot for every 1,000 newborns. This foot has a "down and in" appearance, somewhat resembling MTA. However in these newborns, the heel of the foot is very small and soft, because of a poorly developed heel bone. There is usually a deep crease on the arch area of the foot, where the foot is bent. Children with this problem need an X-ray to properly evaluate the problem. Treatment is initially done by applying repetitive casts in order to bring the foot into a more normal position; however, sometimes a surgery is required in severe cases.

Flexible flat foot is almost a mirror image of a clubfoot, where the foot has an "up and out" appearance, with top of the foot nearly touching the lower leg. This condition occurs more frequently in girls, and is found in five percent of all the newborns. This foot most likely would also need an X-ray evaluation. However, as opposed to a clubfoot, the problem is treated very easily with stretching exercises or splints. The key to successful treatment is to start as early as possible. Stretching is a very easy manipulation that parents should perform with every diaper change. Once the foot has assumed its normal position, a nightly splint is used for another several weeks.

Rigid flat foot, as opposed to its flexible counterpart, is very difficult to treat without resorting to surgery. Fortunately, it is rare in its occurrence. This foot is also known as a "rocker-bottom" foot because of the curved appearance of the sole of the foot. These newborns frequently have other congenital problems, so it is important for them to have a thorough examination. The appearance of the foot, along with X-rays, will make a diagnosis.

Toe problems are among the most common problems encountered in newborns. Extra toes occur more commonly in African American babies (up to 13 per 1,000 births). The most common extra toe is located next to the little toe, but quite frequently an extra toe can be found next to the big toe as well. Usually the extra toe contains only one tiny bone, but in some cases a complete duplication of a toe has occurred. Treatment usually involves a small surgery, preferably before the child is walking, usually at three to nine months of age.

Webbed toes are fairly rare, occurring in one out of 2,000 births. The most commonly involved toes are the second and third. It is thought to be a genetic problem. Webbing is primarily a cosmetic problem, rarely requiring treatment.

Overlapping toes usually occur in both feet. This condition usually runs in families, mostly involving little toe overlapping the fourth toe. Both boys and girls can have overlapping toes. In newborns it is treated by gentle stretching or with night time paper-tape splinting. However, if a child starts to walk before it is corrected, this problem can become more persistent, requiring surgical correction. If treated early, the condition is fairly mild and rarely interferes with walking or running.

Dr. Gore practices in Johnstown, PA. He is a graduate of Kaunas Medical Academy, Lithuania, as well as the California College of Podiatric Medicine. He has completed a podiatric surgical residency as well as traditional family practice residency training. He specializes in pediatric foot problems.
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