What Does Bilateral Clubfoot Mean? A Complete Parent Guide
What does bilateral clubfoot mean? In simple terms, bilateral clubfoot means that both of your baby's feet are affected by the clubfoot condition. The medical term is bilateral congenital talipes equinovarus (bilateral CTEV). While the word "bilateral" may sound intimidating when you first hear it from a doctor or sonographer, it simply indicates that the condition is present on both sides. Around 40-50% of all clubfoot diagnoses are bilateral, making it an extremely common presentation that NHS teams treat regularly with excellent outcomes.
This guide will walk you through everything you need to know about bilateral clubfoot — from what causes it and how it's diagnosed, to the treatment process and the brilliant long-term results you can expect for your child.
Understanding the Terminology
Medical terminology can be confusing, so let's break it down:
- Bilateral: Affecting both sides (both feet)
- Unilateral: Affecting one side (one foot only)
- Congenital: Present from birth
- Talipes: A general term for foot deformities (from Latin: talus = ankle, pes = foot)
- Equinovarus: Describes the specific deformity — equinus (foot pointing downward like a horse's hoof) and varus (foot turned inward)
So "bilateral congenital talipes equinovarus" means: a condition present from birth where both feet are turned inward and downward. It is the same condition as unilateral clubfoot, just affecting both feet.
What Causes Bilateral Clubfoot?
The causes of bilateral clubfoot are the same as for clubfoot in general. It is believed to result from a complex interaction of genetic and environmental factors during early fetal development:
Genetic Factors
Clubfoot has a clear genetic component — it runs in families, and the risk is higher when there is a family history. Some researchers suggest that bilateral clubfoot may indicate a stronger genetic influence, with the theory being that when the genetic predisposition is particularly powerful, it affects the development of both feet rather than just one. Key genetic findings include:
- Genes involved in muscle and connective tissue development (such as PITX1 and TBX4) have been linked to clubfoot
- Identical twins have a higher concordance rate for clubfoot than non-identical twins
- The condition is more common in some ethnic groups, suggesting population-level genetic differences
For a deeper dive into the genetics, read our article on how clubfoot is inherited.
Developmental Factors
During the first trimester of pregnancy, the baby's feet initially form in an inverted (turned-in) position. In normal development, the feet gradually rotate to their correct position. In clubfoot, this rotation fails to complete — and when it fails on both sides, bilateral clubfoot results. This is a developmental process, not something caused by anything the mother did during pregnancy. For more on this topic, see what causes clubfoot during pregnancy.
How Is Bilateral Clubfoot Diagnosed?
Prenatal Diagnosis
Bilateral clubfoot can sometimes be identified during the 20-week anomaly scan. Both feet may be seen in an abnormal position on ultrasound. Bilateral involvement may actually be easier for sonographers to spot than unilateral clubfoot, since both feet appear turned inward.
If bilateral clubfoot is suspected on ultrasound, you may be offered:
- A follow-up detailed scan to confirm the finding
- A referral to fetal medicine to check for any associated conditions (this is routine and precautionary)
- A meeting with the paediatric orthopaedic team before birth to discuss the treatment plan
- Connection with parent support groups
Diagnosis at Birth
Many cases of bilateral clubfoot are first identified at birth during the routine newborn examination. Both feet will be visibly turned inward and downward, and will feel rigid — they cannot be easily moved to the normal position. This immediately distinguishes bilateral clubfoot from positional talipes, which is flexible.
For a visual guide to what clubfoot looks like compared to a normal foot, see our clubfoot baby vs normal foot comparison.
Treatment: The Ponseti Method for Bilateral Clubfoot
The treatment for bilateral clubfoot is the Ponseti method — exactly the same gold-standard approach used for unilateral clubfoot. Both feet are treated simultaneously, following the same stages:
Stage 1: Serial Casting (Typically 5-8 Weeks)
Your baby's orthopaedic team will apply plaster casts to both legs, from toes to above the knee. Each week, the casts are removed, the feet are gently manipulated further towards the correct position, and new casts are applied. The process is gradual and gentle.
With bilateral clubfoot, both feet are cast at the same time during each appointment. Each foot may progress at slightly different rates — one may need more casts than the other — and the team will adjust accordingly. For detailed information about the casting process, read our Ponseti casting guide.
Stage 2: Achilles Tenotomy (Both Heels)
Around 80-90% of children require an Achilles tenotomy to release the tight Achilles tendon. With bilateral clubfoot, the tenotomy is typically performed on both heels, usually during the same procedure. The operation is quick (just a few minutes per foot) and involves a tiny incision at the back of each ankle.
After the tenotomy, both feet are placed in casts for three weeks while the tendons heal at their new, corrected length.
Stage 3: Boots and Bar Bracing (Until Age 4-5)
The boots and bar phase is crucial for maintaining the correction achieved through casting. Your baby will wear special boots attached to a bar, initially for 23 hours a day, then reducing to night-time and nap-time wear until age 4-5.
With bilateral clubfoot, both boots are set at the same angle (typically 60-70 degrees of abduction each). Some parents find that the boots and bar setup feels more natural and symmetrical with bilateral clubfoot compared to unilateral, where one boot is set at a different angle.
Practical Tips for Managing Bilateral Clubfoot
During the Casting Phase
- Clothing: Vests, babygrows with poppers that can be left open at the legs, and sleep bags are your best friends. Many parents buy babygrows a size or two larger and cut the leg seams
- Carrying: Your baby will be heavier with two casts. Use a supportive sling or carrier if possible, and don't be afraid to ask for help with lifting
- Car seat safety: Both legs in casts need to fit comfortably in the car seat. Check that the harness straps still fit correctly
- Nappy changes: Tuck the nappy carefully under both casts to prevent moisture damage. Nappy liners can be helpful
- Bathing: Sponge baths only — the casts must stay completely dry. A damp cloth is fine for cleaning around the casts
During the Boots and Bar Phase
- Sleep: Adjusting to the boots and bar takes time. Our boots and bar sleep guide has practical advice for establishing good sleep routines
- Skin care: Check both feet regularly for blisters, sore spots, and pressure marks. The boots should be firm but not painful
- Travel: The bar can make travel more challenging. Some families find that removing the bar for short car journeys (keeping the boots on) is practical, but always follow your team's advice
- Development: Your baby will learn to kick, roll, and move with the boots and bar. Most babies adapt remarkably quickly
Will My Child Walk Normally?
Yes — the vast majority of children with treated bilateral clubfoot walk completely normally. They typically reach walking milestones at the same age as other children (around 12-15 months). Both feet will function well, and most people would never know your child was born with bilateral clubfoot.
Children with treated bilateral clubfoot can:
- Walk, run, skip, and jump normally
- Participate in all sports and physical activities
- Wear normal shoes (though they may benefit from good-quality supportive footwear)
- Lead completely active, unrestricted lives
Long-Term Outlook
The long-term outlook for bilateral clubfoot treated with the Ponseti method is excellent. Studies following children into adulthood show:
- Patient satisfaction: Over 90% of patients treated with the Ponseti method report good or excellent outcomes
- Foot function: Most adults have near-normal or normal foot function
- Physical activity: The vast majority participate in sports and exercise without limitation
- Pain: Most adults report no or minimal foot pain, though some may experience mild stiffness or fatigue after prolonged activity
For more on what to expect in the longer term, see our article on clubfoot in adults.
Bilateral Clubfoot and DLA
In the UK, families of children with bilateral clubfoot may be eligible for Disability Living Allowance (DLA) to help with the additional care needs during treatment. Bilateral clubfoot may strengthen a DLA application because:
- Both feet are affected, increasing the care burden
- Bilateral casts make handling, feeding, and nappy changing more difficult
- The boots and bar brace affects both legs, impacting mobility and sleep
DLA can help cover additional costs such as larger car seats, specialist clothing, and travel to hospital appointments.
Frequently Asked Questions
Q: What does bilateral clubfoot mean exactly?
A: Bilateral clubfoot means that both of your baby's feet are affected by the clubfoot condition (congenital talipes equinovarus). Both feet are turned inward and downward. It occurs in approximately 40-50% of all clubfoot cases and is treated with the same Ponseti method used for one-sided clubfoot, with equally excellent outcomes.
Q: Is bilateral clubfoot more serious than unilateral?
A: Bilateral clubfoot is not necessarily more "serious" than unilateral clubfoot in terms of treatment outcomes. The Ponseti method is equally effective for both feet, and the treatment timeline is the same since both feet are treated simultaneously. Some researchers suggest bilateral involvement may indicate a stronger genetic component, but this doesn't affect the effectiveness of treatment.
Q: Will both feet look the same after treatment?
A: With bilateral clubfoot, both feet typically look very similar after treatment. This can actually be an advantage compared to unilateral clubfoot, where there may be a subtle size difference between the treated and untreated foot. Most parents find that both feet look normal or very close to normal once treatment is complete.
Q: Does bilateral clubfoot run in families?
A: Clubfoot in general has a genetic component and can run in families. Some research suggests that bilateral clubfoot may have a stronger genetic basis than unilateral. However, many cases of bilateral clubfoot occur in families with no previous history. The recurrence risk depends on family history — see our genetics guide for specific figures.
Q: How do boots and bar work with bilateral clubfoot?
A: The boots and bar setup for bilateral clubfoot involves a boot on each foot connected by a metal bar. Both boots are typically set at 60-70 degrees of abduction (turned outward). Many families find the bilateral setup feels quite natural and symmetrical. The wearing schedule is the same as for unilateral clubfoot — full-time initially, then nights and naps until age 4-5.
Q: Can my baby with bilateral clubfoot still do tummy time?
A: Yes! Tummy time is important for all babies, including those with bilateral clubfoot. During the casting phase, you may need to support your baby's legs slightly. During the boots-and-bar phase, most babies adapt well to tummy time and learn to move and kick with the brace on. Speak to your physiotherapist for specific advice on positioning.