Finding out your newborn has clubfoot raises an immediate question that every parent wants answered: how do babies get clubfoot? You might be searching for a concrete reason — something that happened during pregnancy, something genetic, or something that could have been prevented. The reality is that clubfoot is one of the most common birth differences in the world, affecting around 1 in 1,000 babies born in the UK, and in the vast majority of cases there is no single identifiable cause.
This parent-focused FAQ explains how clubfoot develops, what doctors currently know about the contributing factors, and — just as importantly — what does not cause it. If your child has recently been diagnosed, our newborn clubfoot guide covers the immediate steps and treatment pathway.
What Actually Happens During Development
Clubfoot — the medical term is congenital talipes equinovarus — develops while the baby is still in the womb. To understand how babies get clubfoot, you need to know how feet form in the first place.
Normal Foot Development
Between weeks 4 and 12 of pregnancy, the baby's feet go through an elaborate sequence of growth and rotation:
- Week 4-5: Small buds of tissue appear that will become the legs and feet
- Week 6-7: The foot plate forms at the end of each limb bud, initially pointing inward
- Week 8: Toes start to separate and the bones of the foot begin forming as cartilage templates
- Week 8-12: The foot gradually rotates outward from its initial inward-facing position to sit perpendicular to the shin
Here is the key point: every baby's foot starts in what looks like a clubfoot position. The natural starting position is turned inward and downward. During normal development, the foot rotates out and upward to its final resting position.
What Goes Differently in Clubfoot
In a baby with clubfoot, this outward rotation does not complete. The foot remains partially or fully in its early inward position. By 12 weeks of gestation, the structures of the foot — bones, tendons, ligaments, and muscles — have developed around this abnormal position and locked it in place.
The tendons on the inner side of the foot and behind the ankle are shorter and tighter than normal. The bones of the midfoot and hindfoot are held in an abnormal alignment. The calf muscles on the affected leg are often smaller from the outset. All of this happens very early — well before most women even know they are pregnant.
The Big Question: Why Does This Happen?
Medical researchers have studied clubfoot for decades. The current understanding is that it results from a combination of factors rather than a single cause. Doctors describe it as a "multifactorial" condition.
Genetic Predisposition
Genes play a clear role, though no single "clubfoot gene" has been found. The evidence includes:
- Clubfoot runs in families — if a parent or sibling has it, the risk for a new baby is significantly higher than the general population
- Identical twins are much more likely to both have clubfoot (33%) compared with non-identical twins (3%)
- Boys are affected roughly twice as often as girls, suggesting sex-linked genetic factors
- Certain ethnic groups have higher rates than others, pointing to population-level genetic variation
The current model suggests that many genes each contribute a small amount of risk. When enough of these genetic factors combine in one individual, the threshold for clubfoot is crossed. This is why it can appear in families with no history — the right combination of common genetic variants simply came together by chance.
For a deeper look at the genetic patterns, our article on clubfoot genetics and heredity breaks down the inheritance risks in detail.
Developmental Timing
Because foot rotation happens during a specific window (weeks 8-12), any disruption to normal development during this period can potentially contribute to clubfoot. The developing limb is particularly sensitive to:
- Blood supply variations — the anterior tibial artery, which supplies the front of the foot, may not develop normally in some cases
- Nerve development — abnormalities in the nerves supplying foot muscles can cause muscle imbalance
- Connective tissue development — variations in collagen and ligament elasticity may prevent normal rotation
Environmental Influences During Pregnancy
A small number of environmental factors have been associated with increased risk:
Maternal smoking is the best-documented modifiable risk factor. Studies consistently show a 30-50% increase in clubfoot risk for mothers who smoke during pregnancy, likely due to effects on blood flow and gene expression in the developing limb.
Low amniotic fluid (oligohydramnios) reduces the space for foetal movement, which is important for normal musculoskeletal development. However, this is more commonly linked to positional deformities than to true structural clubfoot.
Certain medications — particularly first-trimester SSRI exposure — have shown modest associations in some studies, though the evidence is not definitive.
Common Myths and Misconceptions
There is a lot of misinformation about clubfoot causes. Here is what does not cause it:
Myth: The Baby Was in a Bad Position
While the baby's position in the womb can cause positional talipes (a flexible, mild foot turning that resolves on its own), true structural clubfoot is not caused by the baby lying in a particular position. The deformity develops at the tissue level during the first trimester, long before the baby is large enough for womb position to matter.
Myth: The Mother Did Something Wrong
Clubfoot is not caused by exercise during pregnancy, work stress, standing too long, eating certain foods, emotional distress, or any other normal maternal activity. It is not a punishment. It is not preventable in the vast majority of cases. Parents — particularly mothers — should not carry guilt about this diagnosis.
Myth: It Is Caused by the Cord Wrapping Around the Foot
This is a persistent folk belief with no medical basis. The umbilical cord does not cause clubfoot. The deformity is established well before the cord could physically interact with the foot in any meaningful way.
Myth: It Only Happens in Certain Countries or Social Classes
Clubfoot occurs in every population worldwide. While rates vary somewhat between ethnic groups (ranging from about 0.5 to 7 per 1,000 births depending on the population), it is found across all nationalities, income levels, and social circumstances. See our article on UK clubfoot statistics for prevalence data.
Myth: It Is Caused by a Lack of Folic Acid
Folic acid supplementation is crucial for preventing neural tube defects (like spina bifida), but there is no strong evidence that folic acid deficiency directly causes clubfoot. Taking folic acid as recommended is important for overall foetal health, but it is not a specific preventative for clubfoot.
Boys, Girls, and Bilateral Cases
Some patterns in who gets clubfoot provide further clues about its origins:
Why More Boys Than Girls?
The male-to-female ratio for clubfoot is approximately 2:1. Several theories exist for this disparity:
- Hormonal differences during foetal development may affect muscle and tendon formation
- Male foetuses have slightly different growth patterns and timing
- There may be sex-linked genetic factors (genes on the X or Y chromosome contributing to risk)
For a thorough examination of this topic, read our article on why clubfoot is more common in boys.
One Foot or Both?
Approximately half of clubfoot cases affect both feet (bilateral) and half affect just one foot (unilateral). When only one foot is affected, the right foot is slightly more commonly involved than the left, though the reason for this asymmetry is unknown.
Bilateral clubfoot may suggest a stronger genetic influence, as the developmental disruption affected both limbs simultaneously. However, the treatment approach and long-term outcomes are similar regardless of whether one or both feet are affected.
When Clubfoot Is Part of Something Bigger
In about 20% of cases, clubfoot is not an isolated finding but occurs alongside other conditions. This is called "non-isolated" or "syndromic" clubfoot. Conditions associated with clubfoot include:
- Spina bifida — nerve damage from the spinal defect can cause muscle imbalance in the feet
- Arthrogryposis — a group of conditions involving multiple joint contractures
- Chromosomal conditions — including Edwards syndrome (trisomy 18)
- Amniotic band syndrome — where strands of the amniotic sac entangle developing limbs
When clubfoot is detected alongside other anomalies, the medical team may recommend additional testing to look for an underlying condition. When clubfoot occurs in isolation (the other 80%), it is classified as idiopathic clubfoot and treated straightforwardly with the Ponseti method.
What This Means for Your Family
Understanding the causes helps put the diagnosis in perspective, but the practical takeaway is straightforward: clubfoot is highly treatable regardless of its cause. The Ponseti method corrects over 95% of clubfoot cases without major surgery. Babies begin treatment within the first few weeks of life, typically starting with a series of gentle casts that gradually move the foot into the correct position.
Your baby's clubfoot says nothing about their future potential. Children with treated clubfoot walk at the normal age, play sport, wear normal shoes, and live without limitation. The condition you are dealing with now is temporary — the treatment works, and the results last.
Frequently Asked Questions
Q: Can clubfoot develop after birth?
A: No. Congenital clubfoot develops during the first trimester of pregnancy and is present at birth. A foot deformity that develops after birth has a different cause — such as nerve damage, muscle disease, or injury — and is classified differently from congenital talipes equinovarus.
Q: I had a normal 20-week scan. How was the clubfoot missed?
A: The 20-week anomaly scan detects many but not all cases of clubfoot. Factors like foetal position, amniotic fluid levels, and the severity of the deformity can make it difficult for the sonographer to see the foot clearly. Detection rates on ultrasound vary between 30% and 80% depending on the study and the skill of the scanner. Clubfoot not detected on scan is not a failure — it simply was not visible at that moment.
Q: Is it more common to get clubfoot in the first pregnancy?
A: Some studies suggest a slightly higher rate in first pregnancies, possibly because the uterus is tighter, providing less room for foetal movement. However, the effect is small and clubfoot occurs commonly in subsequent pregnancies too. Birth order is not a significant risk factor.
Q: Could an infection during pregnancy cause clubfoot?
A: There is no strong evidence linking common maternal infections to isolated clubfoot. Some viral infections (such as Zika virus) have been associated with various birth differences, but these typically cause a broader pattern of anomalies rather than isolated clubfoot. Standard pregnancy precautions against infections are advisable for general foetal health.
Q: My partner's family has no history of clubfoot but mine does. Does that matter?
A: Yes, family history from either parent's side is relevant. Clubfoot genetic susceptibility can be inherited from the mother or the father. When taking family history, consider both sides and include aunts, uncles, cousins, and grandparents as well as parents and siblings.
Q: We are planning another baby. Should we see a genetic counsellor?
A: Genetic counselling can be helpful for understanding recurrence risks, particularly if you have a child with clubfoot and are planning further pregnancies. A counsellor can provide personalised risk estimates based on your specific family history. Ask your GP for a referral to your regional clinical genetics service. Our guide on clubfoot second child risk covers the statistics in detail.
Q: Does IVF or fertility treatment increase clubfoot risk?
A: Some studies have reported slightly higher rates of certain birth differences in IVF pregnancies, but the data on clubfoot specifically are limited and inconsistent. Any potential increase in risk from IVF is very small in absolute terms. Couples undergoing fertility treatment should not add clubfoot worry to their list of concerns.