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CLUBFOOT

Definition

CLUBFOOT

A clubfoot, or talipes equinovarus[1] (TEV), is a


birth defect. TEV is classified into 2 groups
Postural TEV or Structural TEV. Without
treatment, persons afflicted often appear to
walk on their ankles, or on the sides of their
feet. It is a common birth defect, occurring in
about one in every 1,000 live births.
Approximately 50% of cases of clubfoot are
bilateral. In most cases it is an isolated
dysmelia. This occurs in males more often than
in females. The ratio is 2:1.

^ The term talipes is from Latin talus, ankle + pes, foot. Equino-, of or resembling a horse and -varus, turned
inward

Information for the Podiatric Assistant

Vito J. Rizzo, DPM, DABPS, FAPWCA


January 2009

CLUBFOOT

CLUBFOOT
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.

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CLUBFOOT
Appearance in Newborn
clubfoot_baby.jpg

clubfoot_baby.jpg

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Appearance at 6 months

Description

club-foot.jpg
club-foot.jpg

True clubfoot is characterized by abnormal bone formation in the


foot.
Four variations of clubfoot, including talipes varus, talipes valgus,
talipes equines, and talipes calcaneus.
Talipes varus, most common form, foot generally turns inward so
that the leg and foot look somewhat like the letter J.
Talipes valgus, foot rotates outward like the letter L.
Talipes equinus, foot points downward, similar to that of a toe
dancer.
Talipes calcaneus, the foot points upward, with the heel pointing
down.

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Causes

Treatment

Structural TEV is caused by: genetic factors, such as Edwards


syndrome, a genetic defect with three copies of chromosome
18.Growth arrest at roughly 9 weeks and compartment syndrome
of the affected limb are also causes of Structural TEV. Genetic
influences increase dramatically with family history. It was
previously assumed that postural TEV could be caused by
external influences in the final trimester such as from
oligohydramnios or from amniotic band syndrome. However, this
is countered by findings that TEV does not occur more frequently
than usual when the intrauterine space is restricted. [2] Breach
Birth presentation is also another known cause. TEV may be
associated with other birth defects such as spina bifida cystica.
Use of MDMA (Ecstasy) and smoking [3] while pregnant has been
linked with this congenital abnormality.[4

Clubfoot is treated with:


Manipulation
Braces
Serial casting
Splints- knee ankle foot orthoses (KAFO)
Surgery

Wynne-Davies R (1972) Genetic and environmental factors in the etiology of talipes equinovarus. Clin Orthop 84: 913
^ Honein M, Paulozzi L, Moore C (2000) Family history, maternal smoking, and clubfoot: an indication of a gene-environment
interaction. Am J Epidemiol 152: 65865
^ {{McElhatton PR, Bateman DN, Evans C, Pughe KR, Thomas SH (1999). "Congenital anomalies after prenatal ecstasy
exposure". Lancet 354 (9188): 14412.

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CLUBFOOT

Treatment

Treatment

In North America, manipulation followed


by serial casting, most often by the
Ponseti Method. Foot manipulations
usually begin within two weeks of birth

Ponseti Method

The standard in the U.S. and worldwide


Dr. Ignacio Ponseti described in the 1950s, it did not reach a wider
audience until it was re-popularized around 2000 by Dr. John Herzenberg
in the USA and in Europe and Africa.Parents of children with clubfeet
using the Internet [6] also helped the Ponseti gain wider attention. If
correctly done, is successful in >95% of cases [7] in correcting clubfeet
using non- or minimal-surgical techniques. Typical clubfoot cases usually
require 5 casts over 4 weeks. Atypical clubfeet and complex clubfeet may
require a larger number of casts. Approximately 80% of infants require an
Achilles tenotomy After correction has been achieved, maintenance of
correction may require the full-time (23 hours per day) use of a splint
also known as a foot abduction brace (FAB).

^ nosurgery4clubfoot : nosurg
Morcuende JA, Dolan LA, Dietz FR, Ponseti IV (2004). "Radical reduction in the rate of extensive corrective surgery for
clubfoot using the Ponseti method". Pediatrics 113 (2): 37680. PMID 14754952
ery4clubfoot

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Treatment

Casting

Ponseti Method
The developer of the Ponseti Method, Dr Ignacio
Ponseti, at 93 years of age is still treating children
with clubfeet (including complex/atypical clubfeet
and failed treatment clubfeet) at the University of
Iowa Hospitals and Clinics. He is assisted by Dr
Jose Morcuende, president of the Ponseti
International Association.
The long-term outlook [8] for children who experienced
the Ponseti Method treatment is comparable to that
of non-affected children.

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Casting

Bracing

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Treatment

Treatment

Surgery
Extensive surgery of the soft tissue or bone is not
usually necessary to treat clubfoot; however,
there are two minimal surgeries that may be
required:
1. (needed in 80% of cases) is a release (clipping) of the Achilles
2.

tendon - minor surgery- local anesthesia


Anterior Tibial Tendon Transfer (needed in 20% of cases) - where
the tendon is moved from the first ray (toe) to the third ray in order to
release the inward traction on the foot.

Surgery
Of course, each case is different but the main idea is that
extensive surgery is not needed to treat clubfoot.
Extensive surgery may lead to scar tissue developing
inside the child's foot. The scarring may result in
functional, growth and aesthetic problems in the child's
foot because the scarred tissue will interfere with the
normal development of the foot. A child who has
extensive surgery may require on average 2 additional
surgeries to correct the issues presented above.

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Famous people
Many notable people have been born with club foot, including the Roman emperor
Claudius, the poet Lord Byron, statesman Prince Talleyrand, Civil War politician
Thaddeus Stevens, the comedian Damon Wayans, actors Gary Burghoff and Dudley
Moore, footballer Steven Gerrard, mathematician , film director David Lynch, and the
first American president George Washington.[9]

Kristi Yamaguchi was born with a club foot, and went on to win figure skating gold in
1992. Soccer star Mia Hamm was born with the condition. Baseball pitcher Larry
Sherry was born with club feet, as was pitcher Jim Mecir, and both enjoyed long and
successful careers. Pittsburgh Pirates infielder Freddy Sanchez cites his ability to
overcome the defect as a reason for his success [10].

Josef Goebbels, the notorious Nazi propaganda minister, had a right club foot
(possibly incurred after birth as a complication of osteomyelitis)[11], a fact hidden from
the German public by censorship. Because of this malformation, Goebbels needed to
wear a leg brace. That, plus his short stature, led to his rejection for military service in
World War I.

Notable Sarah Lawrence College alum Katherine Bodreau was born with severe club
foot.

CLUBFOOT

The club-foot, by Jos


de Ribera.