Congenital clubfoot: literature review

 Domantas Kunigiškis1, Miglė Sidaraitė1, Inga Ruželytė1

1Lithuanian University of Health Sciences, Faculty of Medicine


Idiopathic clubfoot is in most cases isolated congenital deformity and is defined as fixation of the foot in adduction, supination, varus, and also soft tissue anomalies.  The etiology of clubfoot is complex. Known risk factors include previous cases of clubfoot in the family, amniocentesis, maternal or paternal smoking during pregnancy, gestational diabetes. Genetic predisposition is thought to be the most important risk factor because  of the heritability of the disease and its different occurrence rates in populations of different ethnicities. The disease is thought to be polygenic because males are twice as likely to be afflicted with clubfoot while it is not a sex-linked disease. Accordingly, the Carter effect is observed in clubfoot inheritance which is explained using the polygenic threshold model. Ultrasound can be used to diagnose clubfoot in the prenatal period, usually during 18-24th gestation weeks. The severity of clubfoot is evaluated after childbirth using specific scaled, such as Dimeglio or Pirani scale. X-ray imaging is not used to diagnose clubfoot but is needed for treatment evaluation, for relapse diagnostics, and it also helps to decide on the direction of further treatment. According to studies, Simons’ standardized analytic radiography is the most reliable and is commonly used in cases of clubfoot but the precision of this method is debatable because while evaluating the same images, different results are often produced. Both conservative and surgical treatment can be used to treat clubfoot. Conservative treatment consisting of correction of the position of the foot and immobilization was described by Hippocrates 400 years BC. The same principles apply to modern-day treatment. The Ponseti method is the golden standard for clubfoot treatment in most countries. The method consists of gentle manipulations of the foot, leg plastering, and achillotomy. Later, abduction brace must be worn until the age of 4. Surgical procedures, such as soft-tissue release or tibialis anterior tendon transfer, are not as popular because of the higher risk of relapses and treatment-related complications. Although surgery is still used to treat relapses after conservative treatment, treatment-resistant, syndromic, and neuromuscular cases of clubfoot.

Keywords: clubfoot, talipes equinovarus, clubfeet, Ponseti, French.