Congenital clubfoot is a malformation of the foot that occurs from birth. Its name derives from the fact that its main characteristic is a persistent foot deformity that prevents normal standing on the ground

It is one of the most frequent congenital pathologies, second only to congenital heart malformations.

This deformity can already be diagnosed during pregnancy and early intervention is necessary to avoid complications due to the child’s incorrect foot and leg support.

Features of congenital clubfoot

A child with congenital club-foot has from birth a club-foot (i.e. the toe of the foot is very much pointing downwards), varus (the heel is bent inwards) and supine (the foot is turned on its longitudinal axis).

Specifically:

• equinism is the attitude of the foot with plantar hyperflexion greater than 90°, which may be due to a retraction of the Achilles tendon;
• varus is the deviation of the longitudinal axis of the foot inwards;
• supination is the lifting of the sole of the foot on the inner side of the foot, i.e. the prevailing support on the outer side.

Congenital clubfoot occurs in various forms

• clubfoot, which accounts for 70% of cases and occurs in one case per thousand live births, half of them bilaterally. Basically, the talus (the short bone of the foot located in the tarsus) slides forward and medially. The posterior part of the calcaneus is raised, in equinism, by the Achilles tendon. The subject basically walks on the outer face of the foot, in a supinated position. In addition, the tibia is rotated inwards, with varus joint;
• talus-valgus-pronated foot, 10% of cases, the opposite condition to the previous one, in that the foot is flexed dorsally, in a talus position, while the forefoot is pronated and the hindfoot is valgus;
• metatarsus varus or adductus, 15% of cases, is an incomplete form of congenital clubfoot because it only affects the forefoot, which is varus;
• flat-valgus or reflex foot, only occurs in 5% of cases and is in fact a very rare but also serious condition in which there is a reversal of the arch of the foot with the verticalisation of the talus and calcaneus, therefore the concave face of the foot is no longer the plantar one, but the dorsal one.

Causes

The causes of congenital clubfoot are not yet known, but there are several hypotheses about it.

There seems to be the involvement of both a genetic predisposition and environmental factors.

Among the environmental factors, in addition to dietary and vitamin deficiencies of the pregnant woman, smoking abuse is hypothesised.

The diagnosis of congenital clubfoot can be made during pregnancy by means of an ultrasound scan

The incidence in males compared to females is approximately 3/1 and the deformity manifests itself around 14/16 weeks of intrauterine life with a stunted growth of certain muscle groups in the leg, while the tibia and fibula continue their physiological growth.

The foot then undergoes a medial deviation.

In order to rule out a malformative genesis of a syndromic and neuro-muscular nature, one relies on the prenatal ultrasound diagnosis around the 20th week of pregnancy, on the occasion of the morphological evaluation.

On this occasion, the doctor is able to rule out congenital clubfoot being linked to spina bifida or other malformations of the spinal column.

By stimulating the movements of the foetus, the presence of neuro-muscular pathologies can be ruled out, at least in part.

Even after birth, the doctor may request X-rays of the foot and ankle performed under load (i.e. while standing), in order to get an indication of the degree of the deformity and to assess the changes that have occurred in the lower limb.

Depending on the type of congenital clubfoot, there are different treatments provided

• Club-foot: it is important that therapy is early, i.e. to begin in the first few weeks of life, for it to be successful, and involves manipulation followed by the use of plaster braces. After the third month, surgery is carried out to lengthen the Achilles tendon, possibly associated with capsulotomy and lengthening of other muscle tendons.
• Talus-valgus-pronated foot: treatment of this type of deformity is based on physical therapy and the use of plaster casts, which are usually sufficient for correction.
• Metatarsus varus or adductus: by applying plaster braces or proceeding with a specific capsulotomy surgery, this type of clubfoot can be corrected.
• Flat-forefoot or reflex foot: therapy involves manipulations to correct the counter-curvature of the tarsus and increase the elasticity of the foot.

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Source

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