Clubfoot

deformation of the shape of the foot

and impairment of function
Clubfoot
Etiology
 Unknown
 Most likely a
combination of genetic
and environmental
factors
 Incidence

 1:1000 live births

 Male : Female 2:1
 50% Bilateral
 Location of deformity
 Forefoot-phalanges and
metatarsal
 Midfoot-cuboid
navicular cuneiforms
 Hindfoot-talus calcaneus
 Plane of deformity
 In the hindfoot, coronal
rotation produces heel varus
(medial) or valgus (lateral)

 Sagital plane rotation of the

the hindfoot produced
equinus (plantarflexion) or
calcaneus (dorsiflexion)
 Plane of deformity
 Coronal otation of the
midfoot and forefoot is
discribed as adduction or
abduction as it relates to
medial or laterl deviation
of the foot
 Plane of deformity
 Pronation and supination
are axial rotations
through the midfoot and
the midfoot-forefoot
articulation
Equinus deformity
Supination & heel varus
Forefoot adduction
 Pathology – bones

Talus abnormal relationships including:

 anterior extrusion of the body of the talus

 external rotation of the body in the ankle

mortise, equinus
 medial and plantar deviation of the neck of the
talus
 Pathology – bones

 Calcaneus - Equinus, varus, medial rotation

 Navicular, cuboid – medial subluxation
 Forefoot - adducted and supinated, cavus in
severe cases
 Femur, tibia and fibula - the entire lower limb
can be shorter
 Pathology – muscles

 Imbalance of type I and II, fibrosis caused by

infiltration of fibroblast
 Atrophy of the leg especially in peroneal group,
triceps surae, tibialis posterior, FDL,FHL are
contracted
 Pathology - soft tissues

 Abnoraml colagen structure

 Tendon sheaths - o frequently thickened
 Joint capsules – severe cases: contractures of ankle,
subtalar, talonavicular, calcaneocuboid
 Ligaments - severe cases: contractures of
calcaneofibular + talofibular ligs, deltoid lig, long and
short plantar ligs, spring lig, long plantar lig. (bifurcate
lig)
 Fascia - contracture of fascial planes and of plantar
fascia
 Classification

 Postural - postural or positional talipes can be

passively fully corrected or even overcorrected
 Fixed
1. Flexible
2. Resistant
 Classification – Dimeglio
 soft-soft – postural (20%)
 soft-stiff – correction in saggital and horizontal
planes over 50%, hindfoot varus 20 (33%)
 stiff-soft - correction in saggital and horizontal
planes below 50% (35%)
 stiff-stiff – correction of equinus and varus less
than 20%, hindfoot varus 45 (12%)
 Treatment
 Treatment and outcomes depends on degree of
deformation

 Non-operative
 Operative
 Non-operative
 Series of casts applied as early as first 7-10 of
life
 Casts changed every 7-14 days
 Post treatment options: lower leg splinters,
Dennis-Brown orthosis, footwear,
physiotherapy
 Ponseti method – Achilles tenotomy
 Operative treatment
 Time of surgery – 6-12 months
 Restoration of correct position of bones
 Operative treatment

 Posterior release
 Posteromedial release
 Posteromedial and lateral release
 Complete peritalar release
 Residual deformities

 Forfoot adductus – opening wedge osteotomy of

cuboid, closing wedge osteotomy of calcaneus, partial
resection of calcaneus Lichtblau, calcaneo-cuboid
arthrodesis Evans,
 Foot cavus – osteotomy of calcaneus Dwyer and
Dwyer II
 Over 12 years – triple arthrodesis
 Ilizarov method – secondary correction
 Metatarsus adductus
 MA is medial deviation
of the forefoot at the
level of the midtarsal
joints
 Etiology not completely
understood-packing
abnormalities (abnormal
mechanical intrauterine
forces)
 Metatarsus adductus
treatment
 Spontaneus resolution-only observation
 Home stretching program
 Serial casts
 Surgery
Thanks