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Etiology of the Clubfoot Deformity?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Jan 6, 2022.

  1. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


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    I suggest the etiology of the Clubfoot Deformity is the premature arrest of the torsional development during embryogenesis.

    The prenatal foot develops in a specific and predictable way. It starts as a limb bud (Carnegie Stage 15) which moulds into a clubfoot form (Carnegie State 23). It then continues its’ torsional[ii] growth, through a series of forms (PreClinical Clubfoot and Rothbarts), until it evolves into its’ final plantargrade form[iii].

    If any of these prenatal forms persist into the postnatal[iv] foot, they are considered deformations, and are so named. They are The Clubfoot Deformity, the PreClinical Clubfoot Deformity and the Primus Metatarsus Supinatus Deformity (aka Rothbarts Foot)


    [ii] Reshaping of the foot’s structural orientation relative to the leg, from supinatus to plantargrade
    [iii] Foot’s soles are perpendicular to the body’s plumb line
    [iv] After birth
     
    Last edited: Jan 6, 2022
  2. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Reply 08 on Occam's Razon or the Law of Parsimony

    Below is a summation of my divergent paradigm shift

    A New Classification of Foot Structures Based on Foot Embryology is proposed?

    Basically I have proposed a new 1-4 classification of inherited foot structures based on foot embryogenesis:
    • The ontogenetic (torsional) unwinding (saggital plane) of the cuboid determines the adult position of the lateral column of the foot.
    • The ontogenetic unwinding of the talus determines the adult position of the medial column of the foot.
    Clubfoot Deformity: the ontogenetic unwinding of the entire lateral column of the foot ends prematurely.

    PreClinical Clubfoot Deformity: The cuboid completes its ontogenetic development but the calcaneus and talus remain in supinatus

    Primus Metatarsus Supinatus foot structure: The calcaneus completes its' ontogenetic development, but the talus remains in supinatus (and along with it, the entire medial column of the foot).

    Plantargrade foot: The talus completes its' ontogenetic development
     
  3. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Reply 50 on Occam's Razon or the Law of Parsimony, Gerrard wrote

    You classified the feet of these people without any reference to foot embryogenesis at 12 weeks so your classification does not need to reference this aspect at all .

    As far as I am aware any connection between foot embryogenesis at 12 weeks and the foot types in your classification is purely speculative .

    My reply no 51

    You stated that “As far as I am aware any connection between foot embryogenesis at 12 weeks and the foot types in your classification is purely speculative”

    I disagree and this is why:

    Embryologists have described in detail the normal torsional changes that occur during embryogenesis that shape the limb bud into a supinatus position. And the normal torsional changes that occur during fetalgenesis that mold the foot from a supinatus structure to a plantargrade structure. This torsional unwinding is always linear, proximal to distal (femur to foot).

    Let’s follow this step by step in the developing foot:
    • First the cuboid unwinds (taking with it, the lateral column of the foot), from supinatus to plantargrade (plantar surface perpendicular to the leg).
    • After the calcaneus has completed its positional migration on top of the talus, it starts unwinding, from supinatus to plantargrade.
    • And the finally, after the calcaneus has nearly completed its’ torsional unwinding, the talus inchoates its’ torsional development, and with it, the entire medial column of the foot.
    If we were to look inside the womb and watch this process in real time, this is what we would see:
    • At approximately Week 10pf, we would observe an embryonic foot structure that resembles a clubfoot deformity. That is, both the calcaneus and talus (including the medial column of the foot) would be in supinatus. If this structure was retained (e.g., the calcaneal ontogenetic development prematurely ended at this stage), at birth the baby would be diagnosed as having a clubfoot deformity, a very obvious foot deformity.
    • At approximately Week 11pf, as the foot continues to unwind, we would observe an embryonic foot structure that resembles the PCFD. If this structure was retained (e.g., the calcaneal ontogenetic development prematurely ended at this stage), the infant would be diagnosed as having the PCFD. Before age 4, this diagnosis is difficult to make due to the baby’s prominent fat pad.
    • At approximately Week 12pf, as the foot continues it unwinding, we would observe an embryonic foot that resembles the RFS. If this structure was retained (e.g., the talar ontogenetic development prematurely ended), the infant would be diagnosed as having RFS. Again, before age 4 (there abouts), this diagnosis is difficult to make due to the baby’s prominent fat pad.
    • At Week 36pf, the foot's torsional development has nearly completed. The heel and sole are plantargrade to the Ieg. In the neonatal, I refer to this foot structure as plantargrade.

    So, In summation, With the above understanding, I contend:
    • If the normal ontogenetic foot development (torsional growth) is interrupted at approximately Week 10pf, the baby is born with a Clubfoot Deformity.
    • If the normal ontogenetic foot development (torsional growth) is interrupted at approximately Week 11pf, the baby is born with a PCFD.
    • If the normal ontogenetic foot development is interrupted at approximately Week 12pf, the baby is born with a RFS.
     
  4. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    If I were to challenge my embryological foot classification system, I would do so as follows:

    Q. Why do you contend that the RFS and PCFD represent a fetal stage in which the torsional development has been arrested prematurely?

    A. My answer would be as follows:

    (1) First we see evidence of this in neonatals born with a clubfoot deformity. This foot structure is briefly present during the fetal stage of development. I suggest this abnormal foot structure is an example of an arrested fetal stage present at birth.
    • I realize that my explanation of the etiology of the clubfoot deformity diverges from the current idiopathic explanation.
    • The PCFD and RFS are also the result of an arrested torsional growth in the fetal stage, but occurring later in fetal genesis.
    (2) I have devised a methodology to measure in mms these foot structures (PCFD and RFS) using microwedges (PMSv Test), and differentiate using the KBT.

    (3) The placement of the proprioceptive signal underneath the feet is based on the fetal configuration of these two foot structures. The fact that these insoles are very effective in reversing the gravity drive pronation and associated chronic symptoms provides an indirect confirmation of the correctness of my classification system.

    This would be a very sound challenge to my foot classification system. And ultimately we would agree that posterity will determine the validity of my embryological foot classification system.
     
  5. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Reply #223 from Occam's Razor or the Law of Parsimony

    Gerrard wrote:

    Are you aware of any other adult musculoskeletal conditions that are classified by developmental problems encountered before birth?

    As we discussed previously, classification of club foot is made after a baby is born since seeking to classify before birth makes no clinical sense.

    My Reply #224

    I believe I am the first researcher to make the connection between the prenatal clubfoot shape and the postnatal Clubfoot Deformity.

    You said: Classification of club foot is made after a baby is born since seeking to classify before birth makes no clinical sense .

    I agree. However, I am not classifying the severity of the Clubfoot deformity before birth.

    I am suggesting that the etiology of the Clubfoot Deformity is the result of an arrested torsional growth during embryogenesis
     
  6. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Reply 225 from Occam's Razor or the Law of Parsimony

    Gerrard wrote: Re your use of capitals, you are drawing a distinction between "Clubfoot Deformity" , an entity you claim to have discovered and "Clubfoot deformity" a condition widely recognized in conventional medicine?

    Hi Gerrard,

    Nowhere have I claimed to have discovered the Clubfoot deformity.

    However, I believe I am the first researcher to suggest that the etiology of the Clubfoot deformity is the premature arrest of the torsional growth of the foot during embryogenesis, specifically at Carnegie Stage 23 (See Embryological Plate below) where the PreClinical form is identical to the PreClinical Clubfoot deformity present at birth.
    • It is the torsional growth within the feet that is prematurely arrested.
    • The linear growth is not affected and continues to full term.


    Carnegie Stage 23.jpg

    PreClinical Form present at Carnegie Stage 23: Note the foot supinatus which is structurally identical to the postnatal Clubfoot deformity.
     
    Last edited: Jan 6, 2022
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