Talipes Equinovarus (Clubfoot)
A male infant was born at 38 weeks of gestation to a 36-year-old gravida 3, para 2 woman. Delivery was via emergency cesarean section secondary to nonreassuring fetal heart tones. The pregnancy had been complicated by type A2 gestational diabetes mellitus, cholestasis of pregnancy, and advanced maternal age. The infant’s size was appropriate for gestational age.
Physical examination was significant for deformity of the left foot, which was excessively plantar flexed and rotated medially. The foot was unable to be rotated back to midline. These findings were consistent with unilateral congenital talipes equinovarus, or clubfoot.
Clubfoot is a common congenital malformation that often is diagnosed at the time of birth or during prenatal ultrasonography.1 Clubfoot involves a medial deviation of the talus and abnormal relationships of its communicating bones. Also common are shortening of the fibula and tendons, contractures of the ligaments, and atrophy of the peroneus muscles of the affected leg.
Clubfeet are divided into three categories based on the cause. Postural clubfoot typically is benign and results from fetal positioning in the uterus. It can be associated with oligohydramnios or uterine anomalies. Idiopathic clubfoot, or congenital clubfoot, usually affects all of the anatomic structures of the foot (ie, bones, muscles, blood vessels, and tendons). Syndromic clubfoot is associated with other fetal anomalies, genetic abnormalities, or neurologic disorders.2
The treatment of clubfoot depends on the cause. Positional clubfoot commonly is isolated and self-resolving without intervention. Treatment of congenital clubfoot and syndromic clubfoot depends on the severity but typically involves a series of stretching with bracing and casting.
Treatment outcomes depend on adherence with braces and casting.3 Patients in whom noninvasive treatment fails typically require surgical correction.4 Most patients achieve satisfactory results without significant long-term impairment.2,5,6
REFERENCES:
1. Nemec U, Nemec SF, Kasprian G, et al. Clubfeet and associated abnormalities on fetal magnetic resonance imaging. Prenat Diagn. 2012;32(9): 822-828.
2. Graf A, Wu K-W, Smith PA, Kuo KN, Krzak J, Harris G. Comprehensive review of the functional outcome evaluation of clubfoot treatment: a preferred methodology. J Pediatr Orthop B. 2012; 21(1):20-27.
3. Bergerault F, Fournier J., Bonnard C. Idiopathic congenital clubfoot: initial treatment. Orthop Traumatol Surg Res. 2013;99(suppl 1):S150-S159.
4. Carroll NC. Clubfoot in the twentieth century: where we were and where we may be going in the twenty-first century. J Pediatr Orthop B. 2012;21(1):1-6.
5. Hartge DR, Gaertner S, Weichert J. Prenatal detection and postnatal outcome of congenital talipes equinovarus in 106 fetuses. Arch Gynecol Obstet. 2012;286(4):831-842.
6. Kenmoku T, Kamegaya M, Saisu T, et al. Athletic ability of school-age children after satisfactory treatment of congenital clubfoot. J Pediatr Orthop. 2013;33(3):321-325.