Clubfoot Health Article

Definition

Clubfoot is a condition in which one or both feet are twisted into an abnormal position at birth. The condition is also known as talipes.

Description

True clubfoot is characterized by abnormal bone formation in the foot. There are four variations of clubfoot: talipes varus, talipes valgus, talipes equines, and talipes calcaneus. In talipes varus, the most common form of clubfoot, the foot generally turns inward so that the leg and foot look somewhat like the letter J (when looking at the left foot head-on). In talipes valgus, the foot rotates outward like the letter L. In talipes equinus, the foot points downward, similar to that of a toe dancer. In talipes calcaneus, the foot points upward, with the heel pointing down.

Clubfoot can affect one foot or both feet. Sometimes the feet of an infant appear abnormal at birth because of the intrauterine position of the fetus prior to birth. If there is no anatomic abnormality of the bone, this is not true clubfoot, and the problem can usually be corrected by applying special braces or casts to straighten the foot.

True clubfoot is usually obvious at birth because a clubfoot has a typical appearance of pointing downward and being twisted inwards. Since the condition starts in the first trimester of pregnancy, the abnormality is quite well established at birth, and the foot is often very rigid. Uncorrected clubfoot in an adult causes only part of the foot, usually the outer edge or the heel or the toes, to touch the ground. For a person with clubfoot, walking becomes difficult or impossible.

Demographics

The ratio of males to females with clubfoot is 2.5 to 1. The incidence of clubfoot varies only slightly. In the United States, the incidence is approximately one in every 1,000 live births. A 1980 Danish study reported an overall incidence of 1.2 in every 1,000 children. By 1994, that number had doubled to 2.41 in every 1,000 live births. No reason was offered for the increase.

A family history of clubfoot has been reported in 24.4 percent of families in a single study. These findings suggest the potential role of one or more genes being responsible for clubfoot.

Causes and symptoms

Experts do not agree on the precise cause of clubfoot. Some experts feel that clubfoot may begin early in pregnancy, probably in the 10th to 12th weeks of gestation. The exact genetic mechanism of inheritance has been extensively investigated using family studies and other epidemiological methods. As of 2004, no definitive conclusions had been reached, although a Mendelian pattern of inheritance is suspected. This may be due to the interaction of several different inheritance patterns, different patterns of development appearing as the same condition, or a complex interaction between genetic and environmental factors. The MSX1 gene has been associated with clubfoot in animal studies. But, as of 2004, these findings had not been replicated in humans.

Several environmental causes have been proposed for clubfoot. Many obstetricians feel that intrauterine crowding causes clubfoot. This theory is supported by a significantly higher incidence of clubfoot among twins compared to singleton births. Intrauterine exposure to the drug misoprostol has been linked with clubfoot. Misoprostol is commonly used when trying, usually unsuccessfully, to induce abortion in Brazil and in other countries in South and Central America. Researchers in Norway have reported that males who are in the printing trades have significantly more offspring with clubfoot than men in other occupations. For unknown reasons, amniocentesis, a prenatal test, has also been associated with clubfoot. The infants of mothers who smoke during pregnancy have a greater chance of being born with clubfoot than are offspring of women who do not smoke.

The physical appearance of a clubfoot may vary. However, at birth, an affected foot usually turns inward and points downward. It resists realignment. The calf muscle may be smaller and less well developed than normal. One or both feet may be affected.

When to call the doctor

An pediatrician should be consulted at birth, the usual time clubfoot is initially diagnosed. While there is no immediate urgency, the condition should be evaluated by a pediatrician or an orthopedic surgeon in the first weeks of life so that treatment can be started.

Diagnosis

Clubfoot is diagnosed by physician inspection. This is most often completed immediately after birth. Clubfoot may be suspected during the latter stages of pregnancy, especially in a mother of shorter or smaller than normal stature, a large fetus, or multiple infants.