Most Newborns Have Foot Creases: Is It Normal?

The newborn foot is a complex structure, consisting of 26 to 28 bones. A foot examination is an essential component of a newborn's evaluation, and it can reveal many deformities. The skin should be examined for unusual creases or folds that can be formed by various foot deviations. Creases on the feet are normal, and most newborns have two major creases on the palm. However, the presence of creases over two-thirds of a newborn's feet may be indicative of certain foot conditions such as positional talipes, where the foot turns inwards and downwards, or clubfoot, a congenital deformity with four main components.

Newborn feet abnormalities

Newborn Foot Abnormalities

The newborn foot is a complex structure, consisting of 26-28 bones. It can be divided into three anatomic regions: the hindfoot or rearfoot (talus and calcaneus), the midfoot (navicular bone, cuboid bone, and three cuneiform bones), and the forefoot (metatarsals and phalanges).

An examination of the feet is an essential component of a newborn's evaluation, and most deformities can be diagnosed easily with a physical examination alone. The skin should be examined for unusual creases or folds that can be formed by various foot deviations. The vascular examination consists of an assessment of capillary refill and skin colour, as pulses are difficult to palpate.

• Metatarsus adductus (MTA): This is one of the most common foot deformities, occurring in 1-2 cases per 1,000 live births. It is defined as a transverse plane deformity in Lisfranc's (tarsometatarsal) joints, causing the metatarsals to deviate medially. Mild cases often resolve on their own, but severe cases may need casts, splints, or corrective shoes.
• Clubfoot deformity: Clubfoot describes an array of foot deformities where the newborn's feet are twisted, pointing down and inward. It occurs in 1-4 cases per 1,000 live births, and boys are affected nearly twice as often as girls. Clubfoot can be treated with stretching exercises, casts, and, if necessary, surgery.
• Calcaneovalgus (flexible flatfoot): This is a positional deformity that occurs in about 5% of newborns. It can often resolve on its own but can lead to future complications such as permanent muscle imbalance. Treatment includes stretching exercises, splinting, and, in severe cases, serial mobilization casting.
• Congenital vertical talus (rigid flatfoot): This is a rare deformity that causes the sole of the foot to look like the bottom of a rocking chair. It is treated similarly to clubfoot, with stretching exercises, casts, and, if necessary, surgery.
• Polydactyly: This is the presence of extra toes and occurs in about 1 in 1,000 babies. The treatment depends on where and how the extra toe is connected. Poorly formed toes can be removed with a clip to stop blood flow, causing them to fall off. Better-formed toes are surgically removed when the baby is about one year old.
• Syndactyly: This is the presence of webbed toes and occurs in approximately 1 in 2,000 to 2,500 live births. It is usually a cosmetic problem and rarely requires treatment.
• Overlapping toes: This condition occurs when the fifth digit (the baby toe) crosses over the fourth toe. It can be corrected with gentle stretching or the use of toe spacers. If not corrected before the child starts walking, it may require surgical correction.
• Amniotic bands: These involve toes and fingers and occur in about 1 in 15,000 live births. They are produced by thin bands of amniotic membrane wrapping around the extremity in utero. Simple bands are mainly cosmetic and do not require treatment, but complex bands that cause neurovascular compromise should be surgically released.

Foot examination

An examination of the feet is an essential component of a newborn's evaluation. The newborn foot is a complex structure consisting of 26 to 28 bones, which can be divided into three anatomic regions: the hindfoot or rearfoot (talus and calcaneus), the midfoot (navicular bone, cuboid bone, and three cuneiform bones), and the forefoot (metatarsals and phalanges).

• Simultaneous observation of both feet: By observing both feet together, many deformities can be identified. Look for unusual creases or folds in the skin that may be caused by various foot deviations. Some areas of the skin may appear abnormally taut, indicating extra tension, while other areas may exhibit loose, excessive skinfolds.
• Assessment of joint range of motion: Move the foot and ankle joints through their respective ranges of motion. Evaluate the joints for flexibility, rigidity, unusual positions, lack of motion, and asymmetry.
• Vascular examination: Assess the vascular status of the lower extremities by evaluating capillary refill and skin colour. Pulses may be difficult to palpate, but the majority of newborns exhibit an excellent lower extremity vascular supply unless compromised by an extrinsic factor, such as an intrauterine amniotic band.
• Dermatologic and neurologic evaluation: As part of the overall assessment of the lower extremities, examine the skin and nerves of the feet.

Common newborn foot abnormalities include metatarsus adductus, clubfoot deformity, calcaneovalgus (flexible flatfoot), congenital vertical talus (rigid flatfoot), and multiple digital deformities such as polydactyly, syndactyly, overlapping toes, and amniotic bands. Most of these conditions can be treated with conservative measures such as observation, stretching, and splinting, while some severe cases may require surgical correction by a specialist.

It is important to note that the presence of creases on the feet is not specifically mentioned in the examination guidelines. However, as part of the dermatologic evaluation, any unusual creases or folds on the skin should be noted, as they may be indicative of underlying foot deviations or conditions.

Foot deformities

Metatarsus Adductus (MTA): This is one of the most common foot deformities, occurring in one to two cases per 1,000 live births. It is characterised by a transverse plane deformity in which the metatarsals are deviated medially, causing the toes to angle towards the midline. Treatment depends on the severity and can range from observation to stretching exercises or serial casting and bracing.

Clubfoot Deformity: Clubfoot, or talipes equinovarus, is a congenital deformity that affects the position and shape of the foot and ankle. It can be classified as positional or true clubfoot. Positional clubfoot is caused by the foot being held in an unusual position in the uterus, while true clubfoot is a structurally abnormal foot with underdeveloped bones or muscles. Treatment for clubfoot may include immobilisation with casts, physical therapy, and, in some cases, surgery.

Calcaneovalgus (Flexible Flatfoot): This deformity is characterised by the foot being flat or rounded and bent backward, with the heel turned outward. It is a positional deformity that often resolves spontaneously or with conservative treatment such as stretching exercises or splinting.

Congenital Vertical Talus (Rigid Flatfoot): This is a rare deformity where the hindfoot is in an equinus position, with the forefoot dorsiflexed, resulting in a dislocation of the midtarsal bones. It is a rigid deformity that usually requires surgery, although conservative therapy can be used to stretch the soft tissues.

Polydactyly: Polydactyly is the presence of extra digits on the hands or feet. It occurs in about one to 13 cases per 1,000 live births and is more common in Blacks than Whites. Treatment depends on the complexity of the case and may involve ligation sutures or surgery to remove duplicated structures.

Syndactyly: Syndactyly, or webbed toes, occurs in approximately one in 2,000 to 2,500 live births. It is usually a cosmetic problem and rarely requires treatment. If surgery is desired, it is generally postponed until the child is old enough to participate in the decision-making process.

Other less common foot deformities in newborns include overlapping toes, amniotic bands, metatarsus varus, and pes planus (flat feet).

Positional talipes

It is important to distinguish positional talipes from congenital talipes equinovarus (CTEV) or 'true' clubfoot, which is a structural issue requiring treatment and monitoring. Positional talipes does not indicate any underlying bone deformities, and the affected foot can be easily moved into a normal position. However, babies with positional talipes are at a higher risk of developing torticollis, hip dysplasia, and scoliosis, so a hip examination is recommended.

The treatment for positional talipes is typically conservative, focusing on gentle exercises to stretch the foot and ankle upwards and outwards. Parents are also advised to ensure their baby's clothing is not too tight around the feet and to massage the affected area with oils or lotions to promote flexibility. In most cases, the condition resolves within 12 weeks, with no long-term effects on mobility or walking.

If you have concerns about your baby's feet or notice any stiffness or lack of improvement, it is important to consult a healthcare professional for further advice and examination.

Foot creases and maturity

The newborn foot is a complex structure, consisting of 26 to 28 bones. A thorough examination of a newborn's feet is essential and can be performed quickly. The skin should be examined for unusual creases or folds that can be formed by various foot deviations. Foot creases can be indicative of a baby's maturity. A study by E Damoulaki-Sfakianski, A Robertson, and L Gordero, titled "Skin creases on the sole of the foot as a physical index of maturity: comparison between Caucasian and Negro infants", explores this phenomenon.

During the examination, various foot and ankle joints are moved through their respective ranges of motion. The joints should be assessed for flexibility or rigidity, unusual positions, lack of motion, and asymmetry. This helps identify any potential deformities or issues with the baby's feet.

One common foot condition in newborns is positional talipes, also known as talipes equinovarus (TEV). It is characterised by the foot turning inwards and downwards and is fully flexible or correctable. Positional talipes is thought to be caused by the baby's position in the mother's uterus during pregnancy. It usually improves within a couple of months, and simple exercises can be done to help stretch the foot and ankle in an upwards and outwards direction.

Another common newborn foot abnormality is metatarsus adductus (MTA), which occurs in one to two cases per 1,000 live births. It is defined as a transverse plane deformity in the tarsometatarsal joints, with the metatarsals deviated medially. MTA can be treated with stretching exercises, and in more severe cases, serial casting and bracing may be necessary.

In summary, foot creases can be indicative of a baby's maturity and can also point to potential foot deformities. A thorough examination of a newborn's feet is essential to identify any issues, and in most cases, conservative measures such as observation, stretching, and splinting can be performed easily.

Frequently asked questions