SYMPOSIUM: CLUBFOOT: ETIOLOGY AND TREATMENT
Update on Clubfoot: Etiology and Treatment
Matthew B. Dobbs MD, Christina A. Gurnett MD, PhD
Published online: 18 February 2009
? The Association of Bone and Joint Surgeons 2009
congenital abnormalities affecting the lower limb, it
remains a challenge not only to understand its genetic
origins but also to provide effective long-term treatment.
This review provides an update on the etiology of clubfoot
as well as current treatment strategies. Understanding the
exact genetic etiology of clubfoot may eventually be
helpful in determining both prognosis and the selection of
appropriate treatment methods in individual patients. The
primary treatment goal is to provide long-term correction
with a foot that is fully functional and pain-free. To achieve
this, a combination of approaches that applies the strengths
of several methods (Ponseti method and French method)
may be needed. Avoidance of extensive soft-tissue release
operations in the primary treatment should be a priority,
Although clubfoot is one of the most common
and the use of surgery for clubfoot correction should be
limited to an ‘‘a la carte’’ mode and only after failed
Level of Evidence: Level V, therapeutic study. See
Guidelines for Authors for a complete description of levels
Congenital talipes equinovarus, also referred to as clubfoot,
occurs in one in 1000 live births  and is one of the most
common birth defects involving the musculoskeletal sys-
tem. Although clubfoot is recognizable at birth, the severity
of the deformity can vary from mild to an extremely rigid
foot that is resistant to manipulation. Two classification
systems are widely used in the initial evaluation of clubfoot
deformities. One of these classification systems was
developed by Dimeglio et al.  and the second by Pirani
. Both systems apply a point score based on a number
of different physical findings, which when totaled lead to a
score that correlates with clubfoot severity. Good correla-
tion between the two systems has been demonstrated .
Idiopathic clubfoot is an isolated deformity of the foot
and leg that is identifiable in utero and consists of four
components: equinus, hindfoot varus, forefoot adductus,
and cavus. When untreated, children with clubfoot walk on
the sides and/or tops of their feet, resulting in callus for-
mation, potential skin and bone infections, inability to wear
standard shoes, and substantial limitations in mobility and
The first aim of this review is to provide the readers with
an overview of what is known regarding the etiology of
clubfoot. Because of recent advances in terms of under-
standing clubfoot on a genetic level, emphasis will be
The authors are supported by NIH NINDS K12 Award (NS01690),
the Children’s Discovery Institute, and March of Dimes Basil
O’Connor Award (CAG); and by the Shriners Hospital for Children,
the Saint Louis Children’s Hospital Foundation, and the Pediatric
Orthopaedic Society of North America (MBD).
Each author certifies that his or her institution has approved the
human protocol for this investigation and that all investigations were
conducted in conformity with ethical principles of research, and that
informed consent for participation in the study was obtained.
M. B. Dobbs (&), C. A. Gurnett
Department of Orthopaedic Surgery, Washington University
School of Medicine, One Children’s Place, Suite 4S60, St. Louis,
MO 63110, USA
M. B. Dobbs
St. Louis Shriners Hospital for Children, St. Louis, MO, USA
C. A. Gurnett
Department of Neurology, Washington University School of
Medicine, St. Louis, MO, USA
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