Clubfoot

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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