Congenital Clubfoot

Abstract

Clubfoot (also named congenital talipes equinovarus) is one of the most common congenital foot deformities. Four primary alterations characterize clubfoot: midfoot cavus, midfoot adductus, heel/hindfoot varus, and hindfoot equinus. The incidence of clubfoot ranges between 0.5 and 2 cases per 1000 births. While the precise etiology of isolated clubfoot is multifactorial, genetic and environmental factors play a role. The grade of severity ranges from mild postural forms to severe rigid deformities. The intrauterine ultrasound of the fetus could diagnose the clubfoot. Several classification systems have been proposed in the literature, but the Pirani system is the most commonly adopted due to its reproducibility and validity. Foot X-rays are not indicated in the assessment of clubfoot as treatment decisions are based on the clinical exam.

The gold standard for clubfoot is the Ponseti technique, developed in the 1940s. This technique is divisible into two phases. In the early stage, the progressive casting of the foot aims to correct the deformity, while in the second phase, the focus is on the maintenance of the correction. The Ponseti method has a recurrence rate of 2%, but only 20% of patients will not require Achilles tenotomy and 80% anterior tibialis tendon transfer. Clubfoot is a common deformity in which the treatment requires a strict attention to detail. With proper treatment, the long-term results are excellent and major surgical intervention can be avoided.