Congenital Clubfoot

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.

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].

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.