II. Epidemiology

  1. Often Bilateral
  2. Hereditary
  3. Incidence: 1-2 per 1000 live births
  4. More common in hispanic patients

III. Signs (4 components): Foot is down and in

  1. Images
    1. OrthoPedsFootCF.jpg
  2. Heel inversion (varus) with internal rotation
    1. Medial malleoli are further from each other
  3. Forefoot inverted and adducted (soles face each other)
    1. Medial foot concave
    2. Lateral foot convex (Kidney shape)
    3. Foot inverted
  4. Plantar flexion with inability to dorsiflex
    1. Equinus of Ankle and forefoot
    2. Very tight heel cord
  5. Leg internal rotation

IV. Associated deformity

  1. Congenital dislocation of Hip
  2. Spina bifida
  3. Myotonic Dystrophy
  4. Arthrogryposis

V. Types

  1. Extrinsic Clubfoot (Mild, Supple form)
    1. Secondary to intrauterine compression
  2. Intrinsic Clubfoot (Severe, Rigid form)
    1. Anatomic deformity (e.g. abnormal talus)

VI. Differential Diagnosis

  1. Metatarsus Adductus (foot not in equinus)

VII. Management

  1. Refer immediately for serial casts
  2. Serial Casting
    1. Start in first week of life
    2. Serial Casts weekly for 6-8 weeks
    3. Take advantage of neonatal ligamentous laxity
    4. Manipulate foot before and between casts
      1. Stretches contracted soft tissues
    5. Casting is most effective in extrinsic Clubfoot
    6. Dennis-Browne Splines
    7. Goal is a flat, platform-like base for ambulation
  3. Severe Clubfoot requires surgery
    1. Posteromedial release of heel cords
    2. Major surgery in 50-75% cases

VIII. Patient Resources

  1. Hughston Sports Medicine Foundation
    1. http://www.hughston.com/hha/a_13_4_1.htm

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Ontology: Congenital clubfoot (C0009081)

Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (CHV) a deformity of the foot which occurs at birth in which one or both feet are twisted
Definition (NCI) The most common congenital deformation of the foot, occurring in 1 of 1,000 live births. The most common form is talipes equinovarus, where the deformed foot is turned downward and inward sharply.
Definition (MSH) A deformed foot in which the foot is plantarflexed, inverted and adducted.
Concepts Congenital Abnormality (T019)
MSH D003025
ICD9 754.51
ICD10 Q66.0 , Q66.89
SnomedCT 15169008, 33163000, 156987002, 268340009, 205089003, 268341008, 253957000, 156985005, 397932003, 249808002
English Clubfoot, Talipes Equinovarus, Talipes equinovarus, congenital, CLUBFOOT, CTEV - Congen talip equinovar, CTEV - Congenital talipes equinovarus, Talipes congenital, Clubfoot NOS, Congenital clubfoot, Equinovarus, Clubfeet, Equinovarus deformity, Club feet, feet talipes equinovarus, talipes equinovarus (physical finding), club foot (diagnosis), congenital talipes equinovarus (diagnosis), congenital talipes equinovarus, talipes equinovarus, club foot, Club foot congenital, Clubfoot (congenital), CCF, Clubbed Foot, Clubfoot [Disease/Finding], clubfoot disorders, congenital equinovarus, congenital clubfoot, congenital club foot, Congenital Talipes Equinovarus, Talipe, Pie Torcido, Pie Torcidos, Talipes Equinovarus, Congenital, Talipes, Congenital talipes NOS, Congenital clubfoot NOS, Clubfoot, Congenital, Talipes equinovarus (clubfoot), CLUBFOOT, CONGENITAL, WITH OR WITHOUT DEFICIENCY OF LONG BONES AND/OR MIRROR-IMAGE POLYDACTYLY, Club foot - congenital, Clubfoot (disorder), Clubfoot NOS (disorder), Congenital club foot, Equinovarus - talipes, Talipes equinovarus, Congenital talipes equinovarus, Equinovarus deformity of foot, Clubfoot - congenital, TEV - Talipes equinovarus, Equinovarus deformity of foot (finding), Talipes equinovarus (disorder), clubfoot, clubfoot; deformity, deformity; clubfoot, equinovarus; talipes, equinovarus, talipes; equinovarus, Clubfoot, NOS, Congenital equinovarus
French PIED BOT, Pied varus équin, Pied bot (congénital), Pied bot congénital, Pied bot, PBVE, Pied bot varus équin congénital, Pied bot varus équin, Talipes equinovarus
Spanish PIE ZAMBO, Pie zambo congénito, Talipes equinovarus, Talipes equinovaro congénito, Pie zambo (congénito), Pie equino congenito, Pie zambo, pie zambo equinovaro (trastorno), pie equinovaro (trastorno), pie zambo equinovaro, pie equinovaro, pie zambo (concepto no activo), pie zambo, SAI (trastorno), pie zambo, talipes equinovaro, pie zambo, SAI, talipes, SAI, pie zambo congénito, deformidad en equinovaro del pie (hallazgo), deformidad en equinovaro del pie, Equinovarus, Pie Zambo, Talipes Equinovarus
German KLUMPFUSS, Klumpfuss, Talipes equinovarus, kongenital, Klumpfuss kongenital, Klumpfuss (kongenital), kongenitaler Klumpfuss, Pes equinovarus congenitus, Equinovarus, Pes equinovarus, Talipes equinovarus, Klumpfuß
Dutch congenitale klompvoet, talipes equinovarus, klompvoet (congenitaal), congenitale talipes equinovarus, klompvoet, congenitaal, klompvoet, equinovarus; talipes, klompvoet; misvorming, misvorming; klompvoet, talipes; equinovarus, Equinovarus, Klompvoet, Talipes equinovarus, Voet, klomp-
Italian Piede torto, Piede torto congenito, Piede varo congenito, Piede torto equinovaro, Piede talo equino congenito, Piede torto (congenito), Equinovarus, Talipes equinovarus, Equinismo, Piede equino
Portuguese Pé boto congénito, Pé boto equinovaro, Pé boto, Pé boto cavo congénito, Pé boto equinovaro congénito, PETORTO, Equinovaro, Pé Equinovaro, Pé Torto
Japanese 先天性内反尖足, 内反足(先天性), 先天性内反足, 先天性弯足, ナイハンソクセンテンセイ, センテンセイナイハンセンソク, センテンセイワンソク, ナイハンソク, センテンセイナイハンソク, ナイハンセンソク, 内反尖足, 内反足
Swedish Klumpfot
Czech pes equinovarus, Pes equinovarus, kongenitální, Koňská noha (kongenitální), Pes equinovarus, Kongenitální koňská noha, Talipes kongenitální, Vrozená koňská noha, Koňská noha
Finnish Kampurajalka
Russian EKVINOVARUS, KOSOLAPOST', STOIKAIA EKVINOVARUSNAIA DEFORMATSIIA STOPY, КОСОЛАПОСТЬ, СТОЙКАЯ ЭКВИНОВАРУСНАЯ ДЕФОРМАЦИЯ СТОПЫ, ЭКВИНОВАРУС
Korean 내반 첨족
Croatian KRIVO STOPALO
Polish Stopa końsko-szpotawa
Hungarian Dongaláb (veleszületett), Dongaláb, Congenitalis dongaláb, Veleszületett talipes, Talipes equinovarus, Veleszületett dongaláb, Talipes equinovarus, veleszületett
Norwegian Pes equinovarus, Talipas equinovarus