Atypical/Complex Clubfoot

A small number of clubfoot cases can be classified as atypical (as seen at birth) or complex (aquired from improper casting), and are more difficult to treat. However, they should be able to be corrected without surgery with skilled adjustments and a modified casting technique. With complex cases, you will likely need to see a more skilled doctor for retreatment.


  • Short, fat, or swollen foot

  • Rigid equinus

  • Short and hyperextended (points up) first toe

  • A transverse (across) crease on the sole of the foot

  • Deep crease above the heel

  • Heel area is rigidly tilted inward

  • Foot rigidly flexed downward

  • Heel cord is very tight, wide and long

  • Calf muscle is very small and bunched under the back of the knee.

Improper Casting:

  • Casts should not slip down or completely off (take a picture of the toes during each casting, then you will be able to determine if the cast has slipped when you’re at home).

  • The top of toes should be exposed in the cast

  • A deep crease on the outside of the foot after casting is indicative of overcorrection and this is not appropriate.

  • Below the knee casts are not appropriate for younger children.  Below knee casts do not provide enough force to hold the foot in external rotation. You get more stretching in the medial side leg muscles with above the knee casts. 

  • Serial casting should have casts that are changed weekly, and the post tenotomy casts should be on from about 2-4 weeks

  • you do not want to remove the cast at home the day prior to your schedules appt (you don’t want to lose correction and the casts should not have more than 1 hour lag time in between)

  • After the final cast comes off, there should not be a delay in starting BNB (you don’t want to lose correction)

  • The foot should improve from one cast to the next. Each time a new cast is used, the outward rotation of the foot should change by about 10-15 degrees. The last cast should be set to about 70 degrees of abduction (external rotation) and in atypical cases may abduct to 50 degrees, with a desired 10 degree dorsiflexion.

  • A pediatric orthopaedic surgeon/podiatrist should be casting the child, not a casting tech or nurse

  • Rashes, bruising, and skin irritations under the casts should be addresses with the doctor promptly

  • A deep medial crease on the bottom of the foot, which is indicative of “atypical/complex” clubfoot, should improve with serial casting, not become worse

  • If there was not a deep medial crease at birth and there appears to be a deep medial crease after casting, this is indicative of a typical clubfoot becoming complex clubfoot due to improper casting


The information compiled is from clubfoot family experiences, and the medical community. Doctors and those in the medical field have opinions that may differ. This document is not a substitute for professional medical advice. Consult your doctor with questions. Every clubfoot situation and every clubfoot child's treatment plan may differ slightly.