Clubfoot
Basics
Description
- 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.
Epidemiology
- 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
Pathophysiology
- 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
Etiology
- 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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Citation
Cabana, Michael D., editor. "Clubfoot." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617349/all/Clubfoot.
Clubfoot. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617349/all/Clubfoot. Accessed October 9, 2024.
Clubfoot. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617349/all/Clubfoot
Clubfoot [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 October 09]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617349/all/Clubfoot.
* Article titles in AMA citation format should be in sentence-case
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