Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment

Department of Orthopaedic Surgery, Washington University School of Medicine, One Children's Place, Suite 4S60, St. Louis, MO 63110, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 03/2009; 467(5):1146-53. DOI: 10.1007/s11999-009-0734-9
Source: PubMed


Although clubfoot is one of the most common 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, and the use of surgery for clubfoot correction should be limited to an “a la carte” mode and only after failed conservative methods.
Level of Evidence: Level V, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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    • "When isolated, it is considered idiopathic in 80% to 90% of cases. A genetic etiology of unknown mechanism is strongly suspected [9] [12], given the frequency of familial history (25%), the strong concordance found in monozygotic twins (33%), male predominance (sex ratio = 2.5:1) and ethnic variation. Environmental factors such as smoking, early amniocentesis or viral infection have also been suggested. "
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    ABSTRACT: Clubfoot (talipes equinovarus) is a three-dimensional deformity of unknown etiology. Treatment aims at correction to obtain a functional, plantigrade pain-free foot. The "French" functional method involves specialized physiotherapists. Daily manipulation is associated to immobilization by adhesive bandages and pads. There are basically three approaches: the Saint-Vincent-de-Paul, the Robert-Debré and the Montpellier method. In the Ponseti method, on the other hand, the reduction phase using weekly casts usually ends with percutaneous tenotomy of the Achilles tendon to correct the equinus. Twenty-four hour then nighttime splinting in abduction is then maintained for a period of 3 to 4 years. Recurrence, mainly due to non-compliance with splinting, is usually managed by cast and/or anterior tibialis transfer. The good long-term results, with tolerance of some anatomical imperfections, in contrast with the poor results of extensive surgical release, have led to a change in clubfoot management, in favor of such minimally invasive attitudes. The functional and the Ponseti methods reported similar medium term results, but on scores that were not strictly comparable. A comparative clinical and 3D gait analysis with short follow-up found no real benefit with the increasingly frequent association of Achilles lengthening to the functional method (95% to 100% initial correction). Some authors actually suggest combining the functional and Ponseti techniques. The Ponseti method seems to have a slight advantage in severe clubfoot; if it is not properly performed, however, the risk of failure or recurrence may be greater. "Health economics" may prove decisive in the choice of therapy after cost-benefit study of each of these treatments.
    Full-text · Article · Jan 2013 · Orthopaedics & Traumatology Surgery & Research
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    • "Congenital clubfoot is a three-dimensional malformation with its center in talocalcaneonavicular articulation. The axis of deformation is interosseous talocalcaneal ligament [3]. "
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    ABSTRACT: The purpose of this study was to evaluate the early results of the Ponseti method in reducing extensive corrective surgery rates for congenital idiopathic clubfoot in patients treated in Children's Orthopaedic Clinic and Rehabilitation Department Medical University of Lublin between the years 2007-2011. Thirty-five patients with 47 idiopathic clubfeet were followed prospectively while being managed with the Ponseti method. Clubfoot severity was graded with use of the Dimeglio system. The initial correction was achieved, and early results were measured by using Pirani scoring method.
    Full-text · Article · Jul 2012 · European Journal of Orthopaedic Surgery & Traumatology
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    • "CTEV was most often bilateral, and if unilateral, it more often involved the right side. Earlier studies have found the same (Gurnett et al. 2008, Dobbs et al. 2009, Parker et al. 2009). Moreover, we found that male sex was a strong risk factor, which also supports previous studies (Byron-Scott et al. 2005, Carey et al. 2005, Dickinson et al. 2008). "
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    ABSTRACT: Congenital talipes equinovarus (clubfoot) can present in 2 forms: "syndromic", in which other malformations exist, and the more common "idiopathic" form, where there are no other associated malformations. We analyzed the epidemiology of congenital talipes equinovarus in the Sicilian population, looking for potential etiological factors. Among the 801,324 live births recorded between January 1991 and December 2004, 827 cases were registered (560 males; M/F sex ratio: 2.1). Control infants were randomly selected from a historical cohort of live births without any major congenital malformations. A positive family history of clubfoot, gender, and maternal smoking were found to be risk factors for clubfoot. Patients with clubfoot were born most frequently during the period January-March. No association was found between clubfoot and reproductive history, peri-conceptional maternal drug exposure, maternal education, or ethnicity. Our findings emphasize the importance of birth defects surveillance programs and their usefulness in investigating potential risk factors.
    Full-text · Article · Apr 2012 · Acta Orthopaedica
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