- Clubfoot (talipes equinovarus) is a complex foot deformity consisting of four components:
- Equinus (plantar flexion)
- Hindfoot varus (toward the midline)
- Forefoot adductus
- Midfoot cavus (high arch with overextension)
- Untreated clubfoot can prevent the development of normal gait and result in secondary bone changes leading to lifetime disability.
- Familial occurrence in 25%
- Male > female (2.5:1)
- 50% of cases are bilateral.
- Clubfoot is the most common congenital deformity of the lower extremity.
- 1 to 2:1,000 births in United States
- Lowest prevalence in Chinese, 0.39:1,000
- Highest prevalence in Polynesians, 7:1,000
- Both intrinsic and extrinsic causes have been associated with the development of clubfoot.
- Intrinsic causes:
- Neurogenic (spina bifida)
- Muscular (anomalous or atrophic musculature)
- Vascular (hypoplastic anterior tibial artery)
- Connective tissue diseases (arthrogryposis, Loeys-Dietz syndrome)
- Abnormal primary bone formation
- Interruption of the transcriptional pathway PITX1-TBX4 which is critical to early limb development has been linked to development of clubfoot and similar deformities.
- Extrinsic causes:
- Intrauterine immobility (multiple gestations, malpresentation, uterine abnormalities, oligohydramnios)
- Maternal cigarette smoke exposure
- Most cases (80%) are idiopathic (multifactorial with genetic and environmental influences).
- Remaining cases likely associated with associated structural, genetic, and/or chromosomal anomalies
- Rapid recurrence of deformity should prompt a thorough examination for possible underlying neuromuscular etiologies.
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