Why Physiotherapy Matters for Clubfoot
The Ponseti method does the heavy lifting in clubfoot (talipes) treatment — the casts, the tenotomy, and the boots and bar correct the position of the foot. But physiotherapy plays an important supporting role at every stage, from babyhood through to adulthood.
For babies and young children, gentle stretches help maintain the correction achieved by casting and bracing. For older children, exercises build strength in muscles that may be weaker on the affected side. And for adults who grew up with clubfoot, physiotherapy can help manage stiffness, improve ankle mobility, and reduce pain.
This guide covers exercises and stretches for all ages, but with an important caveat: always follow the advice of your own physiotherapist or orthopaedic team. Every clubfoot is different, and what's appropriate depends on your child's specific situation, stage of treatment, and foot flexibility.
Baby Exercises (0-12 Months)
During and After Casting
During the casting phase itself, there's not much you can do — the casts are doing the work. But between cast changes (if your clinic has a gap between removal and application), gentle handling of the feet helps.
After the final cast is removed and your baby transitions to boots and bar, your physiotherapist may recommend gentle stretches during the daily "off" period.
Gentle Stretching Exercises for Babies
These should be done gently, without force, and ideally after your physio has demonstrated the technique:
- Dorsiflexion stretch: Hold the heel stable with one hand. With the other hand, gently push the top of the foot upward toward the shin. Hold for 5-10 seconds. Repeat 5-10 times. This helps maintain the Achilles tendon length achieved by the tenotomy.
- Eversion stretch: Hold the heel stable. Gently turn the sole of the foot outward (so the sole faces away from the body). Hold for 5-10 seconds. Repeat 5-10 times. This maintains the correction of the inversion (turning in) that characterises clubfoot.
- Toe stretches: Gently wiggle and stretch each toe individually. Clubfoot toes can be slightly stiff, and gentle mobilisation helps.
- Cycling movements: With the boots off, gently move your baby's legs in a cycling motion. This keeps the hip and knee joints mobile and encourages normal movement patterns.
When to Do Baby Exercises
- During the boots-off period (bath time or the designated hour off)
- During nappy changes (a quick 30-second stretch at each change adds up)
- After a warm bath, when muscles and tendons are more relaxed
- When your baby is calm and content — never force stretches on an upset baby
Toddler Exercises (1-3 Years)
Encouraging Movement
As your child begins to stand, cruise, and walk, the best "exercise" is simply encouraging normal movement. Children with treated clubfoot should be encouraged to:
- Walk barefoot on varied surfaces — grass, sand, carpet, wood. Different textures stimulate the foot muscles and sensory development.
- Climb stairs (supervised) — this builds calf strength and ankle flexibility.
- Squat to play — squatting requires ankle dorsiflexion and strengthens the legs bilaterally.
- Stand on tiptoes — reaching for toys on a high shelf encourages calf muscle activation.
Structured Exercises for Toddlers
Make these into games — toddlers don't do "exercises," they play:
- Toe pick-ups: Scatter small soft toys on the floor and encourage your child to pick them up with their toes. This strengthens the intrinsic foot muscles.
- Walking on a line: Use tape or a rope on the floor and ask your child to walk along it. This encourages a straight gait pattern.
- Balance games: Standing on one foot (the affected foot) while you hold their hands. Even a few seconds builds proprioception and ankle stability.
- Trampoline bouncing: A small indoor trampoline (with handle) is brilliant for building leg strength and ankle mobility. Many paediatric physiotherapists recommend them.
Child Exercises (3-10 Years)
Building Strength and Flexibility
By this age, the boots and bar phase is ending or ended, and your child is fully active. The focus of physiotherapy shifts to:
- Maintaining ankle flexibility (particularly dorsiflexion)
- Building calf strength (the affected calf is typically 10-15% thinner than the unaffected side)
- Developing balance and proprioception
- Encouraging a symmetrical gait (walking pattern)
Recommended Exercises
- Calf raises: Standing on the edge of a step with heels hanging off, rise up on tiptoes and slowly lower back down. Start with both feet, progress to single-leg calf raises on the affected side. 3 sets of 10.
- Ankle circles: Sitting with feet dangling, draw circles with the toes. 10 circles in each direction. This maintains ankle mobility in all planes.
- Towel scrunches: Sitting in a chair with a towel on the floor, use the toes to scrunch the towel toward you. Repeat 10 times. Strengthens the intrinsic foot muscles.
- Balance board: Standing on a wobble board or balance cushion. Start with holding onto something, progress to free-standing. Excellent for proprioception.
- Resistance band dorsiflexion: Loop a resistance band around the top of the foot and pull the foot upward against the resistance. 3 sets of 10. Strengthens the tibialis anterior muscle.
Sports and Activities
Children with treated clubfoot can and should participate in sports and physical activities. Swimming is particularly beneficial as it works all the foot and ankle muscles without weight-bearing impact. Cycling, gymnastics, martial arts, and team sports are all appropriate and encouraged.
Adult Exercises (16+ Years)
Why Adults with Clubfoot Need Ongoing Exercise
Adults who were treated for clubfoot as babies may experience:
- Reduced ankle mobility (particularly dorsiflexion)
- Calf muscle asymmetry
- Earlier onset of ankle arthritis
- Occasional pain or stiffness, especially after prolonged standing or high-impact activity
- Compensatory movement patterns affecting the knee, hip, or lower back
Regular exercise helps manage all of these issues. It won't "cure" the underlying structural differences, but it can significantly improve function and reduce discomfort.
Adult Clubfoot Exercise Programme
- Ankle mobility routine (daily, 5 minutes):
- Ankle circles: 20 in each direction
- Alphabet exercise: Trace the alphabet with your big toe
- Wall dorsiflexion stretch: Stand facing a wall, one foot back, lean forward keeping the back heel on the ground. Hold 30 seconds, repeat 3 times.
- Calf strengthening (3x per week):
- Standing calf raises: 3 sets of 15
- Single-leg calf raises (affected side): 3 sets of 10
- Eccentric calf lowers: Rise on both feet, lower slowly on one foot. 3 sets of 10.
- Foot intrinsic strengthening (daily):
- Towel scrunches: 3 sets of 15
- Marble pick-ups: Pick up 20 marbles with your toes
- Short foot exercise: Without curling the toes, try to shorten your foot by drawing the ball of the foot toward the heel. Hold 5 seconds, repeat 10 times.
- Balance training (3x per week):
- Single-leg stand: 30 seconds each side, eyes open, then progress to eyes closed
- BOSU ball exercises
- Single-leg deadlifts with light weight
When to See a Physiotherapist
Referrals for NHS physiotherapy can come through your orthopaedic clinic, your GP, or in some areas you can self-refer. Consider seeing a physio if:
- Your baby's foot seems to be losing flexibility
- Your child is walking with a noticeable limp
- Your child avoids activities because of their foot
- You notice asymmetric wear on shoes
- Your child complains of foot, ankle, or leg pain
- You're an adult with increasing stiffness or pain from your clubfoot
If seeking private physiotherapy, look for a physio experienced in paediatric musculoskeletal conditions. The Chartered Society of Physiotherapy (csp.org.uk) has a directory to find qualified practitioners near you.
Frequently Asked Questions
How often should I do stretches with my baby?
During the boots-off period is ideal — typically once or twice a day. Many parents incorporate a quick stretch into every nappy change (just 30 seconds of gentle dorsiflexion and eversion). Consistency matters more than duration.
Can stretches prevent clubfoot relapse?
Stretches alone cannot prevent relapse — consistent brace wear is the primary prevention. However, maintaining flexibility through gentle stretches supports the overall correction and can help your physio spot any early stiffness that might indicate relapse.
My child's calf is thinner on the clubfoot side. Will exercises fix this?
Some degree of calf asymmetry is permanent in most clubfoot cases. However, targeted calf strengthening can minimise the difference and improve function. The visual difference is usually subtle and most people wouldn't notice it.
Should my child see a physiotherapist regularly throughout childhood?
Not necessarily. If your child is active, flexible, and meeting milestones, formal physiotherapy isn't required. But a check-in with a physio at key stages (starting to walk, starting school, starting secondary school) can be helpful to catch any developing issues early.
I'm an adult with clubfoot and my ankle is getting stiffer. Is physiotherapy worth trying?
Absolutely. Physiotherapy can significantly improve ankle mobility and reduce pain in adults with clubfoot. It won't change the underlying anatomy, but it can make a real difference to daily function and comfort. Ask your GP for a referral.
Read more in our guide: Positional Talipes NHS Exercises: Step-by-Step for Parents.
See our full guide: Positional Talipes in Toddlers: Walking, Monitoring, Referral.
Are there any exercises my child should avoid?
Most activities are safe and encouraged. However, if your child has limited ankle mobility, high-impact activities like long-distance running on hard surfaces may cause discomfort. This varies hugely between individuals — listen to your child's feedback and consult their consultant or physio if unsure.