How Rare Is Bilateral Clubfoot? Understanding the Odds
When parents learn their baby has clubfoot affecting both feet, a common question is: how rare is bilateral clubfoot? The answer may surprise you — bilateral clubfoot is actually not rare at all. Approximately 50% of all clubfoot cases are bilateral, meaning both feet are affected. With clubfoot occurring in about 1 in 1,000 births in the UK, roughly 400 babies are born with bilateral clubfoot each year across the country.
This guide explains the frequency of bilateral clubfoot, how it differs from unilateral clubfoot in terms of treatment and outcomes, and what you need to know as a parent. For background on how bilateral clubfoot occurs, see our article on how bilateral clubfoot happens.
The Statistics: How Common Is Bilateral Clubfoot?
Clubfoot (congenital talipes equinovarus) affects approximately 1 in 1,000 live births in the United Kingdom. Of these cases:
- Bilateral (both feet): Approximately 50% of all cases — some studies report figures between 30% and 50%
- Unilateral (one foot): Approximately 50% of cases
- When unilateral, the right foot is affected slightly more often than the left
In absolute numbers for the UK:
- Approximately 800 babies are born with clubfoot each year in the UK
- Of these, roughly 300–400 have bilateral clubfoot
- Boys are affected approximately twice as often as girls, and this ratio holds for both bilateral and unilateral cases
So while bilateral clubfoot is less common than many other birth variations, it is far from "rare" in the clinical sense. NHS specialist clubfoot teams see bilateral cases regularly and have extensive experience managing them.
Is Bilateral Clubfoot More Severe?
A common misconception is that bilateral clubfoot is "worse" or "more severe" than unilateral. This isn't necessarily true:
Severity Is Not Determined by Laterality
The severity of clubfoot is measured using the Pirani scoring system (0–6 per foot), which assesses the rigidity and degree of deformity. A baby can have mild bilateral clubfoot (low Pirani scores in both feet) or severe unilateral clubfoot (high Pirani score in one foot). The number of feet affected doesn't automatically indicate greater severity.
Treatment Response Is Comparable
Research published in the Journal of Pediatric Orthopaedics consistently shows that the Ponseti method is equally effective for bilateral and unilateral clubfoot. The success rate — approximately 95% — applies to both presentations.
Bilateral May Have Different Associations
Some studies suggest that bilateral clubfoot is slightly more likely to be associated with underlying conditions compared to unilateral clubfoot. When clubfoot is detected prenatally in both feet, the medical team may recommend additional screening to check for conditions such as chromosomal abnormalities or neuromuscular disorders. However, the vast majority of bilateral cases (approximately 80%) are still idiopathic — occurring in otherwise healthy babies with no underlying condition.
Treatment of Bilateral Clubfoot
The treatment for bilateral clubfoot follows the same Ponseti protocol as unilateral cases, applied to both feet simultaneously:
Casting Phase
Both feet are cast at each weekly appointment. The specialist manipulates and casts one foot, then the other. Each foot may be at a different stage of correction — it's common for one foot to respond more quickly. The casting process takes slightly longer per appointment (as both feet need attention) but the overall treatment duration is the same — approximately 4–7 weeks of casting.
For details on the casting process, see our Ponseti casting guide and week-by-week casting guide.
Achilles Tenotomy
Both Achilles tendons may need releasing (tenotomy). This is performed at the same appointment — the procedure takes only a few minutes per foot. A final cast is applied to each foot for approximately three weeks. See our Achilles tenotomy guide for details.
Boots and Bar (Bracing)
The foot abduction brace is actually designed for bilateral use. The bar connects boots on both feet, holding them in the corrected position. In this sense, bilateral clubfoot can actually be slightly easier for bracing — both feet are held symmetrically, and the brace is inherently balanced.
For unilateral cases, the brace holds the affected foot at 60–70 degrees of abduction and the unaffected foot at 30–40 degrees. For bilateral cases, both feet are held at 60–70 degrees, which creates a more symmetrical setup.
The bracing schedule is the same:
- Full-time (23 hours/day) for the first 3 months
- Night-time and naps (12–14 hours/day) until age 4–5 years
Monitoring and Follow-Up
Both feet are monitored at each follow-up appointment. The specialist assesses each foot independently using the Pirani score. Some children may have one foot that corrects perfectly while the other needs additional attention — this is normal and doesn't indicate treatment failure.
Bilateral Clubfoot and Genetics
The genetic aspects of bilateral clubfoot are an active area of research:
- Bilateral cases may have a slightly stronger genetic component than unilateral cases, though this is not conclusively established
- If a parent has bilateral clubfoot, the risk to their child is approximately 3–4%. If a sibling has it, the risk is approximately 2–5%
- Twin studies show higher concordance (both twins affected) in identical twins than fraternal twins, supporting a genetic contribution
- The inheritance pattern is complex (polygenic) — multiple genes are involved, and environmental factors also play a role
For detailed information about the genetics, see our articles on whether clubfoot is genetic and the risk for second children.
Practical Considerations for Bilateral Clubfoot
Mobility and Development
Parents of babies with bilateral clubfoot sometimes worry that having both feet affected will delay mobility more than a single affected foot. Reassuringly, research shows that:
- Children with treated bilateral clubfoot typically walk at the normal age (10–18 months)
- Motor development milestones are usually met on time
- By school age, most children are fully active and participating in sports
- The boots and bar don't delay daytime mobility — children walk, run, and play normally during the hours they're not in the brace
Footwear Considerations
With bilateral clubfoot, both feet may be slightly smaller than average and may differ slightly in size from each other. Most families find that standard children's shoes work fine after treatment. If there's a significant size difference, your specialist may recommend getting shoes fitted individually.
Emotional and Practical Support
Having both feet in casts and then in the brace can feel more overwhelming than a single foot. Connecting with other families who have been through bilateral treatment can be incredibly helpful. UK-based charities like STEPS (Supporting Talipes Equinovarus in Paediatric Services) offer support groups and resources.
Some parents actually find bilateral bracing slightly easier because the brace is more balanced — with both feet weighted equally, babies often find it easier to kick their legs symmetrically.
Long-Term Outcomes for Bilateral Clubfoot
The long-term prognosis for bilateral clubfoot treated with the Ponseti method is excellent:
- Correction rate: Approximately 95%, the same as unilateral cases
- Relapse rate: Approximately 6–10% with good bracing compliance (per foot)
- Walking and function: The vast majority of children walk normally and participate fully in physical activities
- Pain: Long-term studies show minimal pain in properly treated bilateral clubfoot
- Footwear: Most adults wear normal shoes without difficulty
For more on long-term outcomes, see our article on clubfoot in adults.
Frequently Asked Questions
Q: Is bilateral clubfoot genetic?
A: There is a genetic component to all clubfoot, and bilateral cases may have a slightly stronger hereditary element than unilateral cases. However, most babies with bilateral clubfoot have no family history. The genetic contribution is complex and involves multiple genes rather than a single gene. See our genetics guide for more detail.
Q: Does bilateral clubfoot mean my baby has something else wrong?
A: Not necessarily. Approximately 80% of bilateral clubfoot cases are idiopathic — meaning they occur in otherwise healthy babies with no underlying condition. However, bilateral clubfoot is statistically slightly more likely to be associated with other conditions than unilateral. Your medical team will check for associated conditions as part of the standard assessment.
Q: Does bilateral clubfoot take longer to treat?
A: No. Both feet are treated simultaneously, so the overall treatment timeline is the same as for unilateral clubfoot. The casting phase takes 4–7 weeks, the tenotomy adds 3 weeks, and bracing continues until age 4–5. Each appointment may take slightly longer (as both feet need to be manipulated and cast), but the total number of appointments is the same.
Q: Will both feet need the same number of casts?
A: Not necessarily. Each foot is assessed independently, and it's common for one foot to respond more quickly to manipulation than the other. One foot may need 4 casts while the other needs 6 — the specialist tailors the treatment to each foot individually.
Q: Is bilateral clubfoot more common in boys?
A: Clubfoot overall is approximately twice as common in boys as in girls. This ratio applies to both bilateral and unilateral cases. The reasons for this sex difference are not fully understood but may relate to hormonal and genetic factors during development.
Q: Can one foot relapse without the other?
A: Yes. Each foot is monitored independently, and it's possible for one foot to relapse while the other maintains its correction. If this happens, the relapsing foot is treated individually — usually with repeat casting and potentially a tendon transfer — while the other foot continues in the bracing protocol as normal.
Summary
Bilateral clubfoot — clubfoot affecting both feet — occurs in approximately 50% of all clubfoot cases, making it far from rare. Treatment follows the same Ponseti method as unilateral cases, with both feet treated simultaneously. Success rates are excellent and comparable to unilateral cases. The boots and bar brace is designed for bilateral use and may actually be easier to manage than for unilateral cases. With proper treatment through the NHS, the vast majority of children with bilateral clubfoot go on to walk, run, and play completely normally.