Congenital clubfoot (or talipes equinovarus) is one of the most common congenital musculoskeletal anomalies and is characterized by inward rotation of the foot and a range of bony abnormalities that cause walking difficulties and a significant impairment in the quality of life. Antenatal ultrasonography and a thorough clinical assessment in the first several days after birth are essential components of the diagnostic workup.
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 . Although some diseases are assumed to carry an increased risk for this anomaly, the etiology and pathogenesis of congenital clubfoot remain to be elucidated . 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  . 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)    . A bilateral presentation is usually seen, and the feet are described as "bean-shaped"  . 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  . Furthermore, the overall capacity for movement is reduced, resulting in a marked reduction in the quality of life.
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]
Initially, manipulation is directed at the foot deformity rather than the ankle plantar flexion (equinus). After each manipulation, the foot is immobilized in a long leg cast in the maximally corrected position. [patientcareonline.com]
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 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]
(OBQ10.157) A 16-year-old female complains of foot pain with ambulation. She previously underwent clubfoot soft tissue releases at 5 months of age. [orthobullets.com]
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]
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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]
Consequently, variations on the technique arose in the 80s and 90s.84-87 However, the long-term results continued unsatisfactory, with joint and ligament rigidity, ankylosis, weakness of the triceps and of the dorsiflexors, residual deformity due to hypocorrection [scielo.br]
Distraction of the forefoot and midfoot helps to loosen the tightened structures, and derotation of the foot facilitates reduction of the talus • To maintain the gain achieved in passive range of motion, the toe extensors and peroneals are recruited by [orthobullets.com]
Neglected or relapsed cases with excessive scaring can be gradually distracted as described by Ilizarove . [eoj.eg.net]
Joshi designed his J.E.S.S (Joshi's External Stabilizing System), an external fixator system for correction of deformities in clubfoot.  It was based on the principle of Differential Fraction Distraction laid down by Ilizarov. [joas.in]
The removed wedge from shortening of the cuboid bone can be inserted into the osteotomized and distracted osteotomy gap of the medial cuneiform bone for lengthening purposes. [file.scirp.org]
Many studies have stressed the importance of an early diagnosis of congenital clubfoot    , 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  . 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  . 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  . 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) .
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]
[…] 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]
Overall prognosis will often depend on other associated condition. Isolated condition may be treated successfully 8. Promoted articles (advertising) [radiopaedia.org]
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]
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]
International Orthopaedics 17 (1): 11-12 0.87 Japan Yamamoto H (1979) A clinical, genetic and epidemiologic study of congenital club foot. [globalclubfoot.com]
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]
Pathophysiology Various theories of the pathogenesis of clubfoot have been advanced. [nurseslabs.com]
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 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]
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- 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.