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Clubfoot

Clubfoot is a deformity of the foot or ankle that can cause obvious changes in the foot’s appearance, movement, and function. It is also called Clubfoot and Congenital talipes equiovarus (CTEV)

This is a congenital deformity that affects one or both feet. The appearance is similar to the affect foot being rotated to the middle of the ankle (towards the center).

Without treatment, it may appear that those with a clubfoot are walking on the sides of their feet or their ankles. Often though, even with treatment, the majority of patients are able to recover completely – though this is seen more often if treatment is done in childhood.

This condition is relatively common and is seen in 1 of every 1,000 births. 50% of patients are single foot while the other half are both feet.

Males have clubfoot twice as often as Females.

Isolated – If only this birth defect is seen

Complex – If this birth defect is present plus others are seen.

Two groups:

1.)  Postural TEV

2.)  Structural TEV

Three main types of deformities – Joint involvement:

1.)  Inversion at Subtalar Joint –  total hindfoot inversion

2.)  Adduction at talonavicular Joint

3.)  Equinus and Varus at ankle joint –  plantar flexed position – makes the foot tend towards toe walking.

Causes:

–  No single cause for all three deformities.
–  Seen as an isolated birth defect.
–  There are syndromes where this finding is more often seen.
–  Edwards syndrome (Chromosome 18), Growth arrests, Compartment Syndrome – can have a combination of structural TEV
–  Ehlers-Danlos syndrome, Some connective tissues disorders can also be linked with structural cTEV
–  Oligohydramnios, Amniotic band syndrome – may have a link (still unknown completely) to postural cTEV
–  Spina bifida cystica may also have a link to postural cTEV

Screening

–  Most screening done is done prenatally.
–  This is a topic of debate.
–  When done, usually seen through an Ultrasound.
–  Scan is often done around 20 weeks.
–  Clubfoot can be picked up at this time.

Treatment

–  Many different forms of treatment have existed throughout the years.
–  Recently, complex surgical release was the recommended treatment.
–  Many complications occurred due to surgery.
–  Then the idea of serial casting came into view.
–  This is generally used today for basic situations.
–  The idea is that over time, serial casting and leg braces can allow for improved healing and growth.
–  The casting follows the Ponseti Method
–  Foot manipulations begin within two weeks of birth.

More complicated treatment options

–  Surgery to clip the Achilles tendon called Tenotomy  – needed in 80% of cases
–  Anterior Tibila Tendon Transfer –  needed in 20% of cases