Children Gain "Firm Footing" at Shriners Hospital

Brandon Santee (left) and brother Brett team up for a tuba and piano duet.

Like most 14-year-old boys, Brandon Santee enjoys video games, action movies, and most of all, sports. His bedroom bookshelves are adorned with gold, silver and bronze medals awarded for excellence in basketball, track and football. Brandon dreams someday of playing college and professional football, and counts Dallas Cowboys starting quarterback Troy Aikman, among his heroes.

But Brandon and Aikman share something else besides a love of sports. Both were born with talipes equinovarus, or clubfoot.

Brandon Santee's size 11 shoe overshadows the plaster cast he wore in infancy to correct his right clubfoot.

One in 1,000 children in the United States are born with clubfoot each year. Boys are twice as likely as girls to be born with the condition, but clubfoot is usually more severe in girls. Half of all patients have only one foot affected; the other half have a left and right clubfoot.

Brandon was born with a right clubfoot and a normal left foot. Although he endured casts, corrective shoes and surgery as a toddler, he never slowed down.

"He was very active, and even wore out two casts before the age of 3," says Brandon's mom Leatrice.

Readily apparent at birth, clubfoot is a birth deformity in which the foot turns inward and points down, causing walking on the toes and outer sole of the foot, explains Dr. Douglas Barnes, assistant chief of staff at Shriners Hospital for Children in Houston.

"Clubfoot may cause various deformities in the foot," Dr. Barnes says, "but to qualify as true clubfoot, the following three components must be present":

• A tightened Achilles tendon, or heel cord, causes the heel to be drawn up toward the leg, making it impossible to place the foot flat on the floor. This position is referred to as an "equinus" or "plantar flexed" position.
• The foot turns on its side, coming to rest on the outer border of the sole, a condition known as "varus" or "supinated."
• The front half of the foot is adducted or turned inward, giving the foot a kidney bean shape.

In some but not all cases, the arch is abnormally high at the midfoot, a condition called "cavus."

"A true clubfoot is usually stiff and will lack normal motion, be smaller than a normal foot, and the muscles in the adjoining calf will be noticeably smaller," explains Dr. Barnes.

Some of the bones in clubfoot are abnormal not only in their relationship to each other, he says, but also in shape and size. Shortened tendons on the inside of the lower leg together with abnormally shaped bones that restrict movement outward cause the foot to turn inward. A tightened Achilles tendon (the tendon that joins calf muscles to the heel of the foot) causes the heel to be drawn up and the foot to point downward.

The diagnosis of clubfoot is not difficult and is seldom confused with other foot deformities, Dr. Barnes says.

"Occasionally, another foot deformity known as metatarsus varus is confused with clubfoot. However, the "equinus" or raised heel and heel varus (heel turned to the outside) seen in clubfoot is not present in metatarsus varus," he explains.

The presence of clubfoot should prompt a careful search for other musculoskeletal problems, including examination of the back, hip and knees, Dr. Barnes says.

"A malformed foot sometimes relates to problems elsewhere," he explains.

Like his brother Brandon, 6-year-old Brett Santee also was born with congenital clubfoot. While Brandon's right foot only was involved, both Brett's feet were affected. After surgery at Shriner's Hospital, Brett is following in his big brother's footsteps. He proudly displays two gold medals earned for "best tug of war team member" at his elementary school's field day, and faithfully attends all his brother's football games. Brett has become so popular in the stands that the cheerleaders occasionally invite him on the field. In addition, Brett is picking up his brother's love of music. Brandon plays tuba in the school band and won first place in solo and ensemble competitions this year, while Brett is learning to play the piano.

Both boys have completed treatment for clubfoot and are considered "success stories" at Shriners Hospital. They return now and again for checkups, and receive excellent medical reports everytime.

"Be patient, keep your appointments regularly, and do what the doctors tell you to do," advises mom Leatrice. "Clubfoot can be corrected if health professionals, parents and children work together ... it's a team effort all the way."

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©2006 Texas Medical Center

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