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Bilateral Clubfoot Research & Resources

Prenatal Clubfoot: What to Ask at the 20‑Week Scan

Heath

You have weeks, and almost nothing to decide

A prenatal clubfoot (talipes equinovarus outside the United States) diagnosis usually arrives on a routine ultrasound, with months of waiting attached and very few actual decisions, which is a difficult combination. Nothing about the foot changes before birth, no treatment starts, and the useful work is limited to a handful of questions and one arrangement. Pick where you are and get only what applies now.

Written by Heath, who has lived it: casts from birth, a fusion at sixteen, the US Army, and distance running.

Choose the moment

Where are you in this?

The useful questions change as the pregnancy goes on. Pick the stage you are at.

While you are still in the room

Sonographers are often careful with wording because a foot can be hard to see clearly and positional causes look identical on ultrasound. Getting the finding stated precisely is worth more than any reassurance offered alongside it.

AskOne foot or both? How confident are you? Were you able to see the shin and foot bones in the same plane?
AskIs everything else on the scan normal: spine, hands, heart, kidneys, and the amount of fluid?
AskWhat happens next, and who contacts me?
That last one matters mostWhether the clubfoot appears isolated is the single most consequential thing the scan can tell you, far more than the foot itself. It is still provisional: in one cohort, 12 percent of babies thought isolated had another finding after birth.6

The first evening

Almost everyone searches, and almost everyone finds images of untreated feet from settings without access to care. That is not your baby’s trajectory, and the first hour is the worst possible time to meet it.

Worth knowing tonightTreatment is well established and effective, it does not begin until after birth, and nothing you do now changes the foot.
Worth knowing tonightYou did not cause it. The foot forms in the first trimester, often before a pregnancy is confirmed.
Skip the image searchIf you must look, look at treated feet in children, not at photographs of untreated adults.
Do not decide anythingThere is nothing that needs deciding this week, and very little that needs deciding at all before birth.

The long middle

This is where the single genuinely useful task sits: finding out where your baby will be treated, and by whom, before they arrive. It is worth doing early because it is easier now than with a newborn.

Find the providerAsk your obstetric team who treats clubfoot in your region, and whether a referral can be arranged in advance.
Ask the questionAre they formally trained in the Ponseti method, and how many new clubfeet do they treat a year?
Some units offerA meeting with the orthopedic team before birth. If it is available, it is worth taking.
What not to buyNothing. Boots and bars are prescribed and fitted, and no equipment bought now will be the right equipment.

Close to delivery

Clubfoot changes almost nothing about the birth itself. It is not an indication for a caesarean, it does not require a specialist unit on its own, and the baby will not need urgent treatment in the first days.

ExpectA newborn examination that checks the whole baby, not just the feet, and a referral to orthopedics.
TimingCasting typically begins in the first weeks. Starting slightly later does not change the outcome.
Possible surpriseSome prenatally diagnosed feet turn out to be positional and need little or no treatment. It happens, and it is not a mistake anyone made.
Also possibleOccasionally a foot missed on scan is found at birth. The scan is a screen, not a guarantee.

What the ultrasound can and cannot settle

Prenatal detection of clubfoot is reasonably good and it is not definitive in either direction. The image requires the foot and shin bones visible in the same plane, which depends on how the baby is lying, and a positional foot produces the same appearance as a structural one.

So a scan finding means a foot looked abnormal on the day. It does not establish severity, it cannot predict how the foot will respond to casting, and a proportion of findings turn out to be something milder. Assessment after birth is what settles all three.5

The scan can suggestThat a foot looks abnormal, and whether anything else is visible elsewhere.
The scan cannot sayHow severe, how rigid, how it will respond, or whether it is positional.
What matters moreWhether the rest of the scan is normal. Isolated is the word to ask about.

The most useful thing the scan tells you is not about the foot. It is about everything that is not the foot.

The waiting itself

Parents consistently describe the gap between diagnosis and treatment as the hardest part of the whole thing, harder than casting, harder than the brace. Nothing is happening, nothing can be done, and there is unlimited time to construct a version of your child’s life out of fragments found online.

The only counter I know of is to deliberately narrow the horizon. Read about the next stage instead of the next eighteen years, get the provider arranged, and treat the rest of the pregnancy as a pregnancy. It is not a fix, and it is what most families say helped.

The first weeks after birth → When a scan finding is wrong → If clubfoot is never treated → Shoes for the free hours →

People also ask

A prenatal clubfoot diagnosis

Is clubfoot a high risk pregnancy?
Not on its own. Clubfoot changes almost nothing about the birth itself: it is not an indication for a caesarean, it does not require a specialist unit on its own, and the baby needs no urgent treatment in the first hours. What a prenatal finding does change is whether anyone looks harder for anything else, because isolated clubfoot and clubfoot as part of something larger are followed differently.
How can you prevent clubfoot during pregnancy?
You cannot, and anybody promising otherwise is selling something. The foot takes its shape in the first trimester, frequently before a pregnancy is confirmed, and no action during pregnancy is established as preventing it. The evidence that does exist points the other way, at things associated with slightly raised risk rather than at anything protective, and none of it makes an individual pregnancy someone’s fault.
What should I ask at the twenty-week scan?
Whether one foot or both, how confident the sonographer is, and above all whether everything else on the scan is normal. Whether the clubfoot appears isolated matters more than the foot itself.
Can the scan tell how severe it is?
No. It shows that a foot looked abnormal on the day. Severity, rigidity and how the foot will respond to casting are all assessed after birth, and a proportion of findings turn out to be positional.
Is there anything I should do during the pregnancy?
One useful task: find out where your baby will be treated and by whom, and ask whether a referral can be arranged in advance. Nothing about the foot changes before birth and no treatment starts.
Should I buy anything in advance?
No. Boots and bars are prescribed and fitted to the individual foot after casting has finished, so nothing bought during the pregnancy will be the right equipment, and specialist footwear is not needed for months. The one useful preparation is finding out who will treat your baby and where.
Does clubfoot change the birth?
Almost not at all. It is not an indication for a caesarean, does not by itself require a specialist unit, and the baby will not need urgent treatment in the first days.
Why is the waiting so hard?
Because nothing is happening and there is unlimited time to imagine outcomes. Narrowing the horizon to the next stage, arranging the provider, and leaving the rest of the future alone is what most families say helped.

Sources

Where this comes from

1 Diagnosis and Treatment of Idiopathic Congenital ClubfootPediatrics, 2022 2 Management of idiopathic clubfoot: an umbrella review and consensusJournal of Orthopaedic Surgery and Research, 2025 3 Clubfoot overview and treatmentAAOS OrthoInfo 4 ClubfootMedlinePlus, US National Library of Medicine 5 Clubfoot study guidePediatric Orthopaedic Society of North America

Keep going

Related

What the scan shows →Why the image is hard to capture. 6 Can Prenatal Ultrasound and Genetic Testing Reliably Exclude Non-Isolated Clubfoot?de Vries et al. Prenat Diagn, 2026. PMID 41402700 Finding a provider →The one useful task before birth. The first weeks →What happens once the baby arrives.

Compiled by Heath, founder of Clubfoot Forward, an adult with bilateral clubfoot. Orientation for families after a prenatal finding; scan interpretation, referral pathways and birth planning are matters for your obstetric and orthopedic teams. Not medical advice. Reviewed September 2026. See the editorial policy.

Hi, I’m Heath

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