- Discussion:
- congenital clubfoot is a structural foot deformity that is present at birth;
- there is in utero malalignment of the talocalcaneal, talonavicular and calcaneocuboid joints;
- articular malalignments are fixed by contracted joint capsules, ligaments, and contracted foot and ankle tendons;
- may be bilateral in up to 50%;
- occurs in about 1 out of 800 births;
- more common in males than females;
-
pathoanatomy:
- genetic tendency;
- if both parents are normal w/ affected child, risk of next child having clubfoot is 2-5%;
- w/ one affected parent and one affected child, then risk of next child having clubfoot is about 10-25%;
- in some syndromes such as
diastrophic dwarfism, there is autosomal recessive inheritance;
- references:
- Family studies and the course of congenital clubfoot, talipes equinovarus, talipes calcaneovalgus, and metatarsus varus.
Wynne-Davies R:
J Bone Joint Surg Br 46B:445, 1954
- The Genetics of Idiopathic Clubfoot. Fred Dietz, M. CORR 2002;2002:39-48
-
diff dx:
-
myotonic muscular dystrophy
-
arthrogryposis multiplex congenita
-
myelomeningocele club foot
-
poliomyelitis
-
cerebral palsy
- peroneal type of progressive muscle atrophy;
- Radiographic Assessment of Club Foot
- Treatment Options
-
clubfoot casting:
- surgical options:
-
circumferential release: "cincinati incision"
-
Goldner four quadrant approach:
-
medial release
-
posterior release
-
posteromedial release
-
tendon transfers
-
salvage procedures:
-
combined soft-tissue and bone procedures;
- arthrodesis / osteotomy: (
triple arthrodesis)
-
forefoot adduction deformity:
- in the report by AF Lourenco MD et al, the author performed a closing wedge osteotomy
of the cuboid and opening wedge osteotomy of the medial cuneiform in 39 feet;
- clinical and radiographic improvement was seen in all patients, and no complications were seen;
- surgery is advocated in children older than age 4, or when the medial cuneiform ossific nucleus is well developed;
- ref: Treatment of Residual Adduction Deformity in Clubfoot: The Double Osteotomy.
AF. Lourenco, M.D. Journal of Pediatric Orthopedics 2001;21:713-718
- talectomy:
- in the report by J. Legaspi. et al, the authors reviewed 24 feet in 15 patients who had undergone talectomy for recurrent equinovarus deformity;
- 21 were associated with arthrogryposis multiplex congenita, two with myelomeningocele and one with idiopathic congenital talipes equinovarus;
- good results were achieved in eight feet (33%) in which further surgery was not needed and
walking was painless;
- a fair result was obtained in ten feet (42%) in which further surgery for recurrence of a hindfoot deformity had been
necessary but walking was painless;
- remaining six feet (25%) were poor, with pain on walking;
- all patients wore normal shoes and could walk independently, except one who was wheelchair bound because of other joint problems.
- recurrent deformity, the development of tibiocalcaneal arthritis and spontaneous fusion of the
tibia to the calcaneum were all seen in these patients;
- ref: Talectomy in patients with recurrent deformity in club foot. A long term followup study.
J. Legaspi.
J Bone Joint Surg [Br] 2001;83-B
Clubfoot References
Current management of idiopathic clubfoot questionnaire: a multicentric study.
