CHAPTER 51
Clubfoot
Introduction/Etiology/Epidemiology
• Congenital talipes equinovarus (clubfoot) is a complex severe stiff foot deformity, characterized by hindfoot (heel) varus and equinus, and forefoot cavus and adductus (Figure 51-1).
— Pathologically, the ligaments of the posterior aspect of the ankle and of the medial and plantar aspects of the foot are shortened and thickened.
— Calf muscles, including the gastrocnemius, tibialis posterior and anterior, and toe flexors, are shortened and smaller in size.
— Connective tissue rich in collagen tends to spread into the Achilles tendon and deep fascia.
Figure 51-1. (A) Posterior view of moderate infant clubfoot deformity demonstrating heel varus, equinus, and forefoot cavus. (B) Anterior view of moderate bilateral infant clubfoot deformity demonstrating forefoot adduction.
Box 51-1. Syndromes and Disorders Associated With Clubfoot
• Arthrogryposis |
• Myelomeningocele |
• Amniotic band syndrome |
• Proximal femoral focal deficiency |
• Freeman-Sheldon syndrome |
• Larsen syndrome |
• Diastrophic dwarfism |
• Clubfoot may be idiopathic or may occur as part of a disorder (eg, myelomeningocele, arthrogryposis) (Box 51-1).
• Idiopathic clubfoot incidence varies from 0.3 to 8 per 1,000 live births.
• Males are more commonly affected than females (2:1).
• Approximately 50% of cases are bilateral.
• Clubfoot is present at birth (congenital). It is not a malformation; rather, it is a developmental disorder.
• A normally developing foot becomes a clubfoot during the second trimester of pregnancy. Ultrasonography can detect clubfoot after the 14th to 16th week of gestation.
• The etiology, genetics, and pathogenesis of clubfoot have not been clearly established.
•
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