With an incidence rate of 1-2 per 1000 live births, congenital clubfoot is one of the most frequently encountered congenital anomalies of the musculoskeletal system in clinical practice [1]. Although some diseases are assumed to carry an increased risk for this anomaly, the etiology and pathogenesis of congenital clubfoot remain to be elucidated [1]. Congenital clubfoot is also known as congenital talipes equinovarus, where "talipes" stems from words "talus" and "pes" (ankle and foot, respectively), whereas "equinovarus" is derived from "equinus" (horse) and "varus", describing inversion and adduction of the foot [1] [2]. Congenital clubfoot is distinguished by the appearance of four distinct signs - equinus (deformities present in talocalcaneonavicular joint, ankle joint, and the forefoot), varus (inversion of the foot), adductus (complete adduction), and cavus (plantar flexion of the forefoot) [1] [2] [3] [4]. A bilateral presentation is usually seen, and the feet are described as "bean-shaped" [1] [5]. Because of the numerous pathological changes in the bone anatomy, patients suffer from significant walking difficulties as they have to walk on the lateral aspects of their feet (or on the top of their fingers). These pathological factors often result in an inability to wear regular shoes, calf muscle atrophy, but also in skin trauma and secondary infections [1] [3]. Furthermore, the overall capacity for movement is reduced, resulting in a marked reduction in the quality of life.

• Foot Deformity

  If the foot deformity is more severe, also larger operations at the age of one year may become necessary. [klinikum.uni-muenchen.de]

  Although different types of clubfoot exist, the condition is usually accompanied by the following foot deformities: Plantar flexion: Twisting of the ankle. Cavus foot deformity: An unusually high arch in the foot. [my.clevelandclinic.org]

  Congenital talipes equinovarus (CTEV), also known as clubfoot, is common congenital orthopedic foot deformity in children characterized by four components of foot deformities: hindfoot equinus, hindfoot varus, midfoot cavus, and forefoot adduction. [ncbi.nlm.nih.gov]

  Clinically  Small foot  Small calf  Tibia - shortened  Medial and posterior foot skin creases  Foot deformities: ◦ Hindfoot - Equinus + Varus ◦ Midfoot - Cavus ◦ Forefoot - Adduction 9. [slideshare.net]

• Foot Pain

  Foot pain due to abnormal foot positions. Treatment Options Postural: Self resolving. In some cases, physiotherapy intervention for stretching and stimulation to the feet is required. [kkh.com.sg]

  This study showed that the use of this method resulted in no greater severity of foot pain in adulthood to those experienced by people not affected by club foot. [steps-charity.org.uk]

  (SBQ04PE.23) A 7-year-old male with a history of clubfoot surgery presents with pain on the dorsum of his foot with shoewear. The clinical appearance of his foot is shown in Figure A. [orthobullets.com]

• Foot Disease

  intraoperative care, 055932, 関節可動域, ｶﾝｾﾂｶﾄﾞｳｲｷ, range of motion, articular, 061065, 距骨, ｷｮｺﾂ, talus, 052619 キーワード 成長段階, ｾｲﾁｮｳﾀﾞﾝｶｲ, growth stage, 039512, 病気, ﾋﾞｮｳｷ, disease, 017213, *, 足部疾患, ｿｸﾌﾞｼｯｶﾝ, foot disease, 055533, 内反, ﾅｲﾊﾝ, entropion, 040250 [togodb.biosciencedbc.jp]

  What is club foot disease Club Foot is a disease in which there is curvature in the child's feet from birth. According to doctors, one child in one thousand children is affected by this disease. [satpuranews.com]

Many studies have stressed the importance of an early diagnosis of congenital clubfoot [1] [3] [6] [7], primarily because early conservative treatment can be of great benefit in reducing the deformity. For this reason, a thorough clinical assessment shortly after birth and in the next few days is of critical importance for identifying the condition early on [1] [2]. The physician must carefully examine the neonate and observe if the appearance of the foot, its mobility, as well as position are within physiological limits. Plain radiography is of limited use in the neonatal period and early infancy (the reason being incomplete ossification and an unwanted exposure to X-rays) but after 4 months of age X-rays of the feet can be used to evaluate the status of the tarsal and lower leg bones [1] [2]. A prenatal diagnosis might be considered with the use of antenatal ultrasonography, which has been established as an effective method for early recognition of the disorder by some authors [1] [6]. Fetal ultrasound is able to recognize congenital clubfoot as early as at 18-20 weeks of gestation, and when this musculoskeletal anomaly is recognized at a such an early period, amniocentesis is recommended due to the increased frequency of concomitant disorders (e.g. neural tube defects, congenital heart disease, trisomy 18) [1].

The efficacy of the treatment was assessed by Pirani's scoring system before and after treatment. RESULTS: Fifty-two feet achieved a normal appearance within 3 to 6 months (average, 4.2 months) after treatment. [ncbi.nlm.nih.gov]

Abstract We investigated the prognosis and clinical importance of concomitant peroneal nerve palsy in congenital clubfoot. [ncbi.nlm.nih.gov]

Overall prognosis will often depend on other associated condition. Isolated condition may be treated successfully 8. Promoted articles (advertising) [radiopaedia.org]

[…] the upper extremity 485 357 Fractures of the upper extremities 494 358 Tumors of the upper extremities 522 41 Traumatology basic principles 532 413 Diagnosis 533 414 Special injuries 536 415 Therapeutic principles 540 416 Followup management 543 418 Prognosis [books.google.com]

With such a great prognosis coupled with the fact that children with Positional Clubfoot respond so well to conservative strategies, this should be a diagnosis presented with reassurances about outcomes. [blog.dinopt.com]

The etiology of this congenital deformity remains elusive. Muscle anomalies are not commonly found in patients with idiopathic clubfoot, and, when present, their significance is not clear. [ncbi.nlm.nih.gov]

Bengt Källén, Pes Equinovarus, Epidemiology of Human Congenital Malformations, 10.1007/978-3-319-01472-2_22, (111-113), (2013). [doi.org]

International Orthopaedics 17 (1): 11-12 0.87 Japan Yamamoto H (1979) A clinical, genetic and epidemiologic study of congenital club foot. [globalclubfoot.com]

Epidemiological associations From a study of 346 infants with CTEV and 3029 control births, Honein et al. (2000) suggested an association of CTEV with maternal smoking during pregnancy. [ncbi.nlm.nih.gov]

Epidemiology  1-2 in 1000  50% bilateral, Boys 2X  Associations (20%) - SP, CP, AG  ? DDH (Paton RW, 2009)  Family studies: ◦ 30% in identical twins, one parent 3-4% and two parents 30% 5. [slideshare.net]

Paediatric and Perinatal Epidemiology. 2015;29:3. Zionts LE. What's new in idiopathic clubfoot? Journal of Pediatric Orthopedics. 2015;35:547. Morgenstein A, et al. [mayoclinic.org]

There is evidence that development of bone, joint, connective tissue, innervation, vasculature and muscle may each be implicated in the pathophysiology. [boneandspine.com]

Pathophysiology Various theories of the pathogenesis of clubfoot have been advanced. [nurseslabs.com]

Pathophysiology Various theories of the pathogenesis of clubfeet have been advanced, including the following: Arrest of fetal development in the fibular stage Defective cartilaginous anlage of the talus Neurogenic factors Retracting fibrosis Anomalous [emedicine.medscape.com]

After the complete correction, brace wearing is critical for preventing deformity relapse. [ncbi.nlm.nih.gov]

Walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the foot, and result in an awkward gait. Prevention Because doctors don't know what causes clubfoot, you can't completely prevent it. [mayoclinic.org]

1. Anand A, Sala DA. Clubfoot: Etiology and treatment. Indian J Orthop. 2008;42(1):22-28.
2. Nordin S, Aidura M, Razak S, Faisham W. Controversies in Congenital Clubfoot : Literature Review. Malays J Med Sci. 2002;9(1):34-40.
3. Dobbs MB, Gurnett CA. Update on Clubfoot: Etiology and Treatment. Clin Orthop Relat Res. 2009;467(5):1146-1153.
4. Miedzybrodzka Z. Congenital talipes equinovarus (clubfoot): a disorder of the foot but not the hand. J Anat. 2003;202(1):37-42.
5. Elgeidi A, Abulsaad M. Combined double tarsal wedge osteotomy and transcuneiform osteotomy for correction of resistant clubfoot deformity (the “bean-shaped” foot) J Child Orthop. 2014;8(5):399–404.
6. Faldini C, Traina F, Nanni M, Sanzarello I, Borghi R, Perna F. Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases. J Orthop Traumatol. 2016;17(1):81-87.
7. Rosselli P, Nossa S, Huérfano E, et al. Prenatal Ultrasound Diagnosis of Congenital Talipes Equinovarus in Bogota (Colombia) Between 2003 and 2012. Iowa Orthop J. 2015;35:156-159.