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.

• Disability

  Neglected clubfoot can eventually cause a noticeable disability and severely influence the quality life in adulthood. Early recognition and treatment are presumed to be the key for prevention of late disabilities. [ncbi.nlm.nih.gov]

  It can take as little as 5 casts and 20 days to give a child a new chance at disability-free life without requiring surgery. [who.int]

• Surgical Procedure

  Patients who had undergone few (0 to 1) surgical procedures had better functional outcomes than those who had undergone two or more procedures (p < 0.001). [ncbi.nlm.nih.gov]

  Six patients who had been treated with only one surgical procedure had better ranges of motion of the ankle and subtalar joints (p < 0.004) than those who had had multiple surgical procedures. [doi.org]

• Difficulty Walking

  […] on the sides of their feet.[3] This may lead to pain and difficulty walking.[6] The exact cause is usually not identified.[1][3] Both genetic and environmental factors are believed to be involved.[1][3] If one identical twin is affected, there is a 33% [en.wikipedia.org]

• Collapse

  In the few cases described in the literature, the necrosis has involved the entire talus and resulted in progressive fragmentation and collapse. [ncbi.nlm.nih.gov]

  […] dorsalis)(M49.4*) M49.4*신경병증성 척추병증(Neuropathic spondylopathy) 척수공동증 및 구공동증에서의 신경병증성 척추병증(Neuropathic spondylopathy in syringomyelia and syringobulbia)(G95.0＋) 척수로에서의 신경병증성 척추병증(Neuropathic spondylopathy in tabes dorsalis)(A52.1＋) M49.5*달리 분류된 질환에서의 허탈성 척추(Collapsed [dic.impact.pe.kr]

  We performed decancellous and collapse of cuboid instead of wedge osteotomy of cuboid. [file.scirp.org]

  The collapse of idealism following the political compromise that led to the establishment of the Free State and the Civil War also had a profound impact on the language movement and its literary programme that was part of the cultural nationalist aspiration [scribd.com]

• Rigor

  In his introduction and notes, Louis de Paor argues that Irish language poetry should be evaluated according to its own rigorous aesthetic rather than as a subsidiary of the dominant Anglophone tradition of Irish writing. [scribd.com]

• Foot Deformity

  Introduction Anatomy Presentation Physical exam inspection small foot and calf shortened tibia medial and posterior foot skin creases foot deformities hindfoot in equinus and varus differentiated from more common positional foot deformities by rigid equinus [orthobullets.com]

  This treatment gives good results for most children and so surgery is not usually needed to correct the foot deformity. What is talipes? Talipes is also known as club foot. It is a deformity of the foot and ankle that a baby can be born with. [patient.info]

  Congenital Foot Deformities—Advances in Research and Treatment: 2012 Edition is a ScholarlyPaper™ that delivers timely, authoritative, and intensively focused information about Congenital Foot Deformities in a compact format. [books.google.com]

  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]

  […] angle greater than 15º talonavicular subluxation: medial subluxation of the navicular on the talus Ultrasound Approximately 10-20% of individuals with prenatally diagnosed clubfoot may have a normal foot or positional foot deformity requiring minimal [radiopaedia.org]

• 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]

• Muscular Atrophy

  Syndromic talipes equinovarus arises in many neurological and neuromuscular disorders, for example spina bifida or spinal muscular atrophy, but the idiopathic form is by far the most common. The upper limb is normal in idiopathic CTEV. [ncbi.nlm.nih.gov]

  Central and peripheral nervous system disorders that are associated with AMC include a condition in which the brain and spinal cord do not close before birth (meningomyelocele), the spinal muscular atrophies, and disorders in which there is incomplete [rarediseases.org]

• Genu Valgum

  In many cases a well-marked genu valgum is present. Bursae and callosities develop over the weight- bearing areas. [boneandspine.com]

• Fear

  […] of great worry or anxiety caused by the knowledge of danger fright [noun] a sudden fear funk [noun] (a state of) fear scare [noun] a feeling of fear or alarm [dictionary.cambridge.org]

  Indreabhán : this collection was nominated for the Aristeon European Prize for Poetry 1998 2006: By the Hearth in Mín a' Leá: translations by Seamus Heaney and Frank Sewell, Arc Publications : The Poetry Society (UK) Translation Choice for 2006 2015: An Fear [en.wikipedia.org]

  Maoiliúra Iníon léinn i bPáras A female student in Paris ‘Codail a laoich’ ‘Sleep, my prince’ Colm Breathnach(1961–) Tréigean Abandonment Macha Macha Ba chlos dom cór I heard a choir Nóibhíseach Novice An croí The heart Madonna Madonna Gorta Famine An fear [scribd.com]

• Anger

  Acknowledge and accept an expression of feelings of frustration, dependency, anger, grief, and hostility; support verbalization of positive or negative feelings about the actual or perceived loss; and be realistic and positive during treatments, in health [nurseslabs.com]

• Abnormal Gait

  At the time of follow-up, no patient showed an abnormal gait, all feet were plantigrade and flexible, but 2 feet (2.9%) had relapsed. LEVEL OF EVIDENCE: Therapeutic Level IV. [ncbi.nlm.nih.gov]

  This abnormal gait can cause focal loading on a small area and can be painful. Clubfoot is detectable via prenatal ultrasound in the second trimester. [orthopaedicsone.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].

Treatment in clubfoot aims at correction of the deformity to obtain functional, plantigrade, pain-free foot. [eoj.eg.net]

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.