Talipes Equinovarus epidemiology

NewsBot · Jun 29, 2010

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Epidemiology of congenital idiopathic talipes equinovarus in Iowa, 1997-2005.
Kancherla V, Romitti PA, Caspers KM, Puzhankara S, Morcuende JA.
Am J Med Genet A. 2010 Jun 25;152A(7):1695-1700. [Epub ahead of print]

Congenital idiopathic talipes equinovarus (ITEV), also known as clubfoot, is a well-recognized foot deformity. To date, prevalence estimates and descriptive data reported for ITEV have varied due to differences in study methodology. Using population-based surveillance data collected by the Iowa Registry for Congenital and Inherited Disorders, we examined isolated ITEV births delivered from 1997 through 2005 and compared to live births in Iowa during the same time period. An overall prevalence was calculated for live, singleton full-term births only. Prevalence odds ratios (POR)s and 95% confidence intervals (CI)s were examined for selected infant and parental characteristics. The prevalence of isolated ITEV was 11.4 per 10,000 live, singleton full-term births (95% CI = 10.3, 12.6), with no significant variation in prevalence during the study period. Increased PORs were found for males (POR 1.8; 95% CI = 1.5, 2.3) and maternal smoking during pregnancy (POR = 1.5, 95% CI = 1.2, 1.9); low birth weight (<2,500 g) showed an increase among females (POR = 3.2, 95% CI = 1.5, 6.9) but not males (POR = 0.9, 95% CI = 0.3, 2.8). Elevated, but non-significant, PORs were found for season of birth, maternal education, and trimester prenatal care was initiated; decreased PORs were found for fetal presentation, maternal race/ethnicity, parity, area of residence, and parental age at delivery. Our study of a well-defined, homogenous sample suggested that prevalence of isolated ITEV in Iowa was similar to that reported in other population-based studies and provided support for some, but not all, previously reported associations with infant and parental characteristics. More detailed, longitudinal studies of isolated ITEV are recommended.
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NewsBot · Nov 3, 2010

Incidence of clubfoot in Uganda.
Mathias RG, Lule JK, Waiswa G, Naddumba EK, Pirani S.
Can J Public Health. 2010 Jul-Aug;101(4):341-4.

BACKGROUND: While the congenital clubfoot deformity is a common deformity recorded in Uganda, the incidence of the condition had never been accurately determined. The objective of this study was to measure the overall incidence of congenital clubfoot deformity in a representative sample of births.

METHODS: A study of all babies born with foot anomalies took place from March 2006 to October 2007. The study was based at 8 Regional Hospitals with active maternity units and a functioning clubfoot clinic. All babies with foot deformities at birth at any of eight centres as detected by the delivery room staff were referred to the respective centre's clubfoot clinic. The children were examined by clubfoot clinic orthopedic officers who diagnosed the specific deformity. Children referred to the clinic from any source and born at the maternity unit were included in the study. The denominator was all live births at the centre during the study period.

RESULTS: The total number of live births during the study period was 110,336. The maternity units of the centres identified 290 infants with a foot deformity. One hundred and thirty infants born during the study period were diagnosed in the clubfoot clinic as having a congenital clubfoot deformity. The proportion of infants with a clubfoot deformity was 1.2 per 1000 births over the 20-month period. The male to female ratio was 2.4:1.

RECOMMENDATION: The rate of clubfoot deformities in the newborn can be used to estimate the numbers of children who should be treated and to estimate resource needs for the identification and management of this treatable congenital malformation. By comparing the number of those treated with the expected number of cases, the numbers of children with neglected clubfoot can be calculated.
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NewsBot · May 2, 2013

Demographics of Children Attending Clubfoot Clinics at Two Academic Hospitals
SP Swai, G Firt
Bone Joint J 2013 vol. 95-B no. SUPP 14 70

Purpose of Study The management of idiopathic clubfoot has changed substantially over the past fifty years with the Ponseti method of treatment gaining increasing popularity in recent years. The advantages of this method are its simplicity and minimal resource requirements with high published success rates. One of the disadvantages is that unless treatment protocols are meticulously adhered to, especially in the bracing stage, recurrence will occur. This study explores the demographics and highlights existing barriers to successful clubfoot treatment outcomes at two academic hospitals.

Description of Methods A cross sectional study was conducted of all children undergoing clubfeet treatment between June and December 2011. A stratified questionnaire was used at two academic hospitals.

Summary of Results A total of 135 children were included, 49 (36.3%) female and 86 (63.7%) male. Over 98% of the children were born in hospital. Fifty five children, (40.8%, almost half), travelled over 30 km to attend the clinic every week. One hundred and thirteen children (83.7%) made use of public transport. Most parents (83 children, 63.7%)had secondary school education. The majority of families, 111 children (82.2%), had a combined household income of less than R2000 per month. Sixty four children (47.4%) received a child dependency grant.

Conclusion The majority of children attending these two clubfoot clinics came from households earning less than R2000 a month and almost half of them travelled more than 30 km a week to attend the clubfoot clinic. Outreach programmes and satellite clinics with properly trained staff for the management of clubfoot are desperately needed in Gauteng Province to ease the burden on the families of children with clubfeet and facilitate compliance with treatment.
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NewsBot · May 23, 2013

Descriptive Epidemiology of Idiopathic Clubfoot
Martha M. Werler et al
American Journal of Medical Genetics Part A; Early View

Clubfoot is a common structural malformation, occurring in approximately 1/1,000 live births. Previous studies of sociodemographic and pregnancy-related risk factors have been inconsistent, with the exception of the strong male preponderance and association with primiparity. Hypotheses for clubfoot pathogenesis include fetal constraint, Mendelian-inheritance, and vascular disruption, but its etiology remains elusive. We conducted a population-based case–control study of clubfoot in North Carolina, Massachusetts, and New York from 2007 to 2011. Mothers of 677 clubfoot cases and 2,037 non-malformed controls were interviewed within 1 year of delivery about socio-demographic and reproductive factors. Cases and controls were compared for child's sex, maternal age, education, cohabitation status, race/ethnicity, state, gravidity, parity, body mass index (BMI), and these pregnancy-related conditions: oligohydramnios, breech delivery, bicornuate uterus, plural birth, early amniocentesis (<16 weeks), chorionic villous sampling (CVS), and plural gestation with fetal loss. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for state. Cases were more likely to be male (OR: 2.7; 2.2–3.3) and born to primiparous mothers (1.4; 1.2–1.7) and mothers with BMI ≥30 kg/m2 (1.4; 1.1–1.8). These associations were greatest in isolated and bilateral cases. ORs for the pregnancy-related conditions ranged from 1.3 (breech delivery) to 5.6 (early amniocentesis). Positive associations with high BMI were confined to cases with a marker of fetal constraint (oligohydramnios, breech delivery, bicornuate uterus, plural birth), inheritance (family history in 1st degree relative), or vascular disruption (early amniocentesis, CVS, plural gestation with fetal loss). Pathogenetic factors associated with obesity may be in the causal pathway for clubfoot
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NewsBot · Sep 2, 2013

Prevalence of developmental dysplasia of the hip in children with clubfoot
Daud TS Chou, Manoj Ramachandran \
Journal of Children's Orthopaedics; August 2013

Purpose
The relationship between congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip (DDH) remains uncertain. The role of routine hip screening in children with CTEV is debated. A recent study has found a high incidence of DDH in patients with CTEV. The aim of our study was to determine the true prevalence of radiographic hip dysplasia and identify the need for routine hip screening in patients treated for CTEV.

Methods
From a single centre database of 165 children consisting of 260 CTEV, a prospective radiological prevalence study of 101 children was performed over a period of 3 months. A single anterior-posterior pelvic radiograph was performed at a minimum age of 5 months. The DDH was determined by a single senior investigator based on the age-adjusted acetabular index (AI) as described by Tonnis.

Results
There were no dislocations or subluxations. According to the age-adjusted AI, 16 children had ‘light’ dysplasia and one child had ‘severe’ dysplasia. The child with severe dysplasia was known to have DDH and had already undergone treatment. The 16 children with light dysplasia did not require any form of treatment.

Conclusion
Out of one hundred and one children with CTEV, only one had DDH requiring treatment. This is consistent with the majority of the literature supporting the premise that there is no true association between CTEV and DDH. We, therefore, feel that routine hip screening for children with CTEV is not supported by current evidence and cannot be recommended.
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NewsBot · Sep 14, 2013

Is it worthwhile to screen the hip in infants born with clubfeet?
Dahang Zhao, Weiwei Rao, Li Zhao, Jianlin Liu, Yaqing Chen, Pinquan Shen, Qing Du, Luan Li
International Orthopaedics; September 2013

Purpose
There is some disagreement about whether idiopathic congenital talipes equinovarus (CTEV) increases the risk of neonatal developmental dysplasia of the hip (DDH). This study aimed to investigate the incidence of DDH in our infants with idiopathic CTEV.

Methods
We conducted an observational cohort study over a three-year period to assess the relationship between idiopathic CTEV and DDH. All neonates younger than six weeks with idiopathic CTEV who were treated in our medical centre were admitted to this study. Each subject underwent hip ultrasound examination using the Graf method at the age of six weeks. DDH was diagnosed when a hip was type IIa(−) or worse according to the Graf classification of sonographic hip type.

Results
A total of 184 patients were diagnosed with idiopathic CTEV and underwent hip sonography. In total, seven hips of five individuals underwent treatment (four girls and one boy). The results indicated that 2.7 % of babies (five of 184) with idiopathic CTEV had DDH. However, we did not find any statistically significant difference (p = 0.5776) in the Pirani scores between the DDH group and group with normal hips.

Conclusions
This study revealed that the idiopathic CTEV group had a greater incidence of DDH in comparison with the general population. It is recommended that hip sonography be undertaken particularly in patients with idiopathic CTEV.
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NewsBot · Sep 24, 2013

Evaluation of online health information on clubfoot using the DISCERN tool.
Kumar VS, Subramani S, Veerapan S, Khan SA
Journal of Pediatric Orthopedics. Part B [2013]

The Internet has become a major source of health information on various aspects of clubfoot diagnosis and management. The World Wide Web becomes the first knowledge portal for a large number of anxious parents seeking information on clubfoot. Thus, a good quality webpage should provide necessary and comprehensive information on clubfoot so as to establish clarity in treatment options, compliance and bracing protocols. In contrast, modest quality information can induce bias and poor follow-up. We objectively evaluated online health information on clubfoot using the DISCERN tool. Using the universal search engine, Google, we conducted a Boolean search for the term 'clubfoot'. Only the first 50 sites providing health information on clubfoot were included in the study. We examined 334 links to include 50 of them. During analysis three websites were excluded because of duplication of content leaving 47 websites that were examined using the DISCERN tool. As per this tool, a score of less than 40% was graded as 'poor', 40-79% as 'fair' and at least 80% as 'good', whereas the overall quality was graded as 'low', 'moderate' and 'high' on similar standards. The overall quality of the publication was 'low' in 40% (19) websites, 'moderate' in 28% (13) and 'high' in 32% (15) of the websites we evaluated. Six (13%) of the publications showed good reliability; 25 (54%) showed fair reliability and 16 (33%) were unreliable. With regard to the quality of information on treatment choices, 44.7% (21) were 'good', 46.8% (22) were 'fair' and 8.5% (four) were 'poor'. We conclude that the quality of websites providing online health information on clubfoot needs significant improvement with emphasis on a universally acceptable template for disease information.
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NewsBot · Oct 1, 2013

An descriptive epidemiological study on congenital clubfoot in China during 2001 to 2010
Yi L, Zhou GX, Dai L, Li KS, Zhu J, Wang Y
Journal of Sichuan University. Medical Science Edition [2013, 44(4):606-609]

OBJECTIVE: To understand the trend of prevalence of congenital clubfoot and its epidemiological characterisitics in China during 2001 to 2010.

METHODS: The data of the perinatal children with congenital clubfoot from 2001 to 2010 in the birth defects monitoring program were collected and analyzed, and the perinatal children were defined from the pregnancy of 28 weeks to postnatal 7 days, including live births, fetal deaths and stillbirths. SPSS16.0 software was used to analyze the data.

RESULTS: A total of 4,233 cases were identified with congenital clubfoot among 8 273 382 births, with a prevalence of 5.12/10(4). There was no increasing trend or decreasing trend on the prevalence of congenital clubfoot to be found in China during 2001 to 2010 (chi2 = 2. 43, P > 0.05). The prevalence of congenital clubfoot in urban and rural areas was 4.90 and 5.43 per 10 000 births respectively. The prevalence of congenital clubfoot in male and female babies was 5.31 and 4.3 per 10,000 births respectively. The prevalence of congenital clubfoot in west, middle and east region was 7.00, 4.52 and 4.27 per 10,000 births respectively. The prevalence of congenital clubfoot in south and north region was 5. 82 and 4. 34 per 10,000 births respectively. The difference between them is statistically significant (P < 0.05). The distribution of affected area between male and female was not significantly different (chi2 = 1.74, P < 0.05).

CONCLUSION: There was no increasing or decreasing trend on the prevalence of congenital clubfoot to be found in China during 2001 to 2010. The prevalence of congenital clubfoot in China was found with regional differences and gender differences. The prevalence of congenital clubfoot in Chinese population is greater than foreign populations.
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NewsBot · Oct 16, 2013

Prospective Evaluation of a Prenatal Sonographic Clubfoot Classification System
Glotzbecker M.P. · Estroff J.A. · Curtis T.A. · Kalish L.A. · Spencer S.A. · Parad R.B. · Kasser J.R. · Mahan S.T.
Fetal Diagn Ther (DOI: 10.1159/000354554)

Background: The purpose of this study was to prospectively evaluate our recently described fetal sonographic classification system for prenatal diagnosis of clubfoot.

Methods: Over 18 months, we prospectively enrolled consecutive pregnant patients evaluated for a prenatally diagnosed clubfoot. Prenatal sonographic scores assigned by a radiologist were compared to final clinical diagnosis and severity given by a pediatric orthopedic surgeon. Pearson's χ2 test and logistic regression were used in statistical analyses on the subject level. Generalized estimating equations were used in analyses on the foot level to account for intrasubject correlation.

Results: There were 50 subjects, with 26 unilateral and 24 bilateral clubfeet, according to the prenatal ultrasound (US). A total of 51 (69%) of 74 feet and 36 (72%) of 50 subjects had a postnatal diagnosis of clubfoot. The accuracy of diagnosis in cases of a severe, moderate, and mild US score was 94, 70, and 25%, respectively (p = 0.003 comparing moderate-severe vs. mild). US severity correlated with the Dimeglio classification scoring system (Spearman's correlation 0.30).

Conclusion: The fetal sonographic scoring system is predictive of clinical severity after birth, and improves the ability to counsel families with a prenatal diagnosis of clubfoot
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NewsBot · Oct 22, 2013

Clubfoot Image Classification
Amanda Marie De Hoedt
University of Iowa Masters Thesis 2013 (pdf)

NewsBot · Nov 5, 2013

Is It Worthwhile to Routinely Ultrasound Screen Children With Idiopathic Clubfoot for Hip Dysplasia?
Mahan ST, Yazdy MM, Kasser JR, Werler MM.
J Pediatr Orthop. 2013 Oct 29.

PURPOSE::
Patients with idiopathic clubfoot are considered at increased risk for having developmental dysplasia of the hips (DDH). However, the studies showing this association have been relatively small. Many clinicians who treat idiopathic clubfoot routinely screen the hips of these patients with ultrasound or radiograph due to the concerns of increased risk of DDH. We evaluated a large clubfoot population to determine the risk of DDH and compare this to a population of children without clubfoot. We also evaluated if the clubfoot patients found to have DDH would have been discovered by standard DDH screening.

METHODS::
We identified infants in 3 states (MA, NY, NC), who were reported to each state's birth defects registry as having a clubfoot. A second cohort of infants without clubfoot was also identified as a control group. Mothers of these children were contacted to be included in the study, and a computer-assisted telephone interview was administered by one of the study nurses, including questions about treatment of DDH. The child's median age at interview was 7 months. Mothers of clubfoot cases were also contacted for follow-up at mean age of 3.3 years.

RESULTS::
Families of 677 patients with clubfoot and 2037 controls were interviewed. A total of 5/677 (0.74%) patients with clubfoot and 5/2037 (0.25%) controls reported having their infant treated with a brace or harness for hip problems (P=0.134). Of the patients with clubfoot, 2 of them did not need treatment for their DDH and 2 would have been discovered by standard hip screening. Follow-up study at 3.3 years of age found no serious late hip dysplasia.

CONCLUSIONS::
Treatment of DDH was uncommon in all children; the higher proportion in infants with clubfoot was not statistically different than controls. Of the patients with clubfoot and DDH, standard hip screening would have been appropriate and others did not need treatment. These data suggest that routine hip ultrasound or radiographic screening of idiopathic clubfoot patients is not necessary unless indicated by the standard infant hip screening.
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NewsBot · Nov 18, 2013

Clubfoot Care in Low-Income and Middle-Income Countries: From Clinical Innovation to a Public Health Program
Luke Harmer, Joseph Rhatigan
World Journal of Surgery; November 2013

Background
Clubfoot occurs in nearly 1 in every 1,000 live births worldwide, representing a significant burden of disease. In high-income countries, an evidence-based treatment protocol utilizing sequential casting was pioneered by Ponseti and has resulted in excellent outcomes among children treated for this condition. However, treatment methods and results of treatment vary greatly across low- and middle-income countries (LMICs). Our goal was to create a framework for understanding how effective programs that treat clubfoot in LMICs choose and organize their activities.

Methods
A systematic literature review was conducted using the keywords “developing countries” and “clubfoot.” A public health analysis model known as the Care Delivery Value Chain (CDVC) was applied to discover public health practices that would optimize value over the entire course of a patient’s life.

Results
The literature review yielded 32 unique results, seven of which met our inclusion and exclusion criteria. Review of the bibliographies yielded two additional papers for a total of nine papers. We identified seven vital steps in the clubfoot cycle of care and constructed a CDVC.

Conclusions
The analysis of this CDVC model suggests six best practices that are essential to successfully scaling up clubfoot treatment programs and ensuring excellent clinical outcomes: (1) diagnosing clubfoot early; (2) organizing high-volume Ponseti casting centers; (3) using nonphysician health workers; (4) engaging families in care; (5) addressing barriers to access; (6) providing follow-up in the patient’s community. These practices must be adapted to each context. Applying them will optimize outcomes when designing public health programs that deliver clubfoot care in LMICs.
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NewsBot · Jan 18, 2014

Prevalence of developmental dysplasia of the hip in children with clubfoot.
Chou DTs, Ramachandran M.
J Child Orthop. 2013 Oct;7(4):263-7
.

PURPOSE:
The relationship between congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip (DDH) remains uncertain. The role of routine hip screening in children with CTEV is debated. A recent study has found a high incidence of DDH in patients with CTEV. The aim of our study was to determine the true prevalence of radiographic hip dysplasia and identify the need for routine hip screening in patients treated for CTEV.
METHODS:
From a single centre database of 165 children consisting of 260 CTEV, a prospective radiological prevalence study of 101 children was performed over a period of 3 months. A single anterior-posterior pelvic radiograph was performed at a minimum age of 5 months. The DDH was determined by a single senior investigator based on the age-adjusted acetabular index (AI) as described by Tonnis.
RESULTS:
There were no dislocations or subluxations. According to the age-adjusted AI, 16 children had 'light' dysplasia and one child had 'severe' dysplasia. The child with severe dysplasia was known to have DDH and had already undergone treatment. The 16 children with light dysplasia did not require any form of treatment.
CONCLUSION:
Out of one hundred and one children with CTEV, only one had DDH requiring treatment. This is consistent with the majority of the literature supporting the premise that there is no true association between CTEV and DDH. We, therefore, feel that routine hip screening for children with CTEV is not supported by current evidence and cannot be recommended.
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NewsBot · Jun 3, 2014

Unilateral versus bilateral clubfoot: an analysis of severity and correlation.
Gray, Kelly; Barnes, Elizabeth; Gibbons, Paul; Little, David; Burns, Joshua
Journal of Pediatric Orthopaedics B: 27 May 2014

This study compares the severity of unilateral and bilateral clubfoot, and the correlation between right and left feet of bilateral cases. Sixty-six unilateral and 75 bilateral clubfoot patients were assessed for severity using the Pirani score at an average age of 12.9 days (SD 9 days). In bilateral cases, the severity of right and left feet was highly correlated (r=0.68). The odds of being very severe were 2.6 (95% confidence interval 1.3-5.1) times higher in bilateral cases (P=0.007). Bilateral and unilateral clubfeet present with differing severity. Right and left feet from bilateral cases are highly correlated. Researchers need to address these issues during study design and analysis.
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NewsBot · Jun 10, 2014

The Contralateral Foot in Children with Unilateral Club foot, Is the unaffected side normal?
Anthony Cooper, Christine Alvarez, Harpreet Chhina, Alyssa Howren
Gait & Posture; Available online 5 June 2014

Highlights
• Pedobarographic measurements of unilateral unaffected clubfoot are not same as normal controls.
• The unaffected foot should not be referred to as normal, nor should it be used as a control.
• Timings of initiation of stance differ significantly between normal and unaffected clubfeet.
• Unaffected clubfoot accumulates differences from normal feet due to maturation of gait with age.
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NewsBot · Nov 1, 2014

Prevalence and prenatal ultrasound detection of clubfoot in a non-selected population: an analysis of 549,931 births in Tuscany
Viola Seravalli, Anna Pierini, Fabrizio Bianchi, Sabrina Giglio, Francesca Vellucci, and Ettore Cariati
Journal of Maternal-Fetal and Neonatal Medicine

Objective To evaluate the prevalence and prenatal ultrasound detection of clubfoot in Tuscany during a period of 20 years.

Methods This is a descriptive analysis on data from the Tuscan register of congenital defects, covering a 20-year period from 1992 to 2011. The Tuscan registry of congenital defects is a population-based register for the epidemiologic surveillance of congenital anomalies. The study included all cases of pre- or postnatally diagnosed clubfoot (isolated clubfoot and cases associated with other congenital defects). Overall prevalence and prenatal detection rates were calculated.

Results Among the 549,931 deliveries recorded in Tuscany between 1992 and 2011, 858 cases of clubfoot were registered, with a prevalence of 1.56/1,000. Seventy-eight percent of cases were isolated. The detection rate was higher when the defect was associated with other anomalies compared to isolated forms. Over the study period, there was a substantial improvement in the prenatal detection of clubfoot (from 11 to 31% overall). For isolated forms, detection rate improved from 4 to 16%, and for cases associated with other congenital defects, it increased from 43 to 73%.

Conclusion
Prevalence of clubfoot in Tuscany is 1.56 per 1,000 births, in agreement with the incidence reported in epidemiological studies in Europe. Prenatal detection of clubfoot improved over time. The detection rate was higher in cases associated with other anomalies.
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NewsBot · Nov 8, 2014

Is congenital talipes equinovarus a risk factor for pathological dysplasia of the hip?
a 21-year prospective, longitudinal observational study
R. W. Paton, Q. A. Choudry, R. Jugdey, S. Hughes
Bone Joint J 2014;96-B:1553–5.

There is controversy whether congenital foot abnormalities are true risk factors for pathological dysplasia of the hip. Previous United Kingdom screening guidelines considered congenital talipes equinovarus (CTEV) to be a risk factor for hip dysplasia, but present guidelines do not. We assessed the potential relationship between pathological dysplasia of the hip and fixed idiopathic CTEV.

We present a single-centre 21-year prospective longitudinal observational study. All fixed idiopathic CTEV cases were classified (Harrold and Walker Types 1 to 3) and the hips clinically and sonographically assessed. Sonographic Graf Type III, IV and radiological irreducible hip dislocation were considered to be pathological hip dysplasia.

Over 21 years there were 139 children with 199 cases of fixed idiopathic CTEV feet. Sonographically, there were 259 normal hips, 18 Graf Type II hips, 1 Graf Type III hip and 0 Graf Type IV hip. There were no cases of radiological or sonographic irreducible hip dislocation.

Fixed idiopathic CTEV should not be considered as a significant risk factor for pathological hip dysplasia. This conclusion is in keeping with the current newborn and infant physical examination guidelines in which the only risk factors routinely screened are family history and breech presentation. Our findings suggest CTEV should not be considered a significant risk factor in pathological dysplasia of the hip.
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NewsBot · Nov 21, 2014

Congenital Talipes Equinovarus: Frequency of Associated Malformations not Identified by Prenatal Ultrasound
M. Hassan Toufaily, Marie-Noel Westgate and Lewis B. Holmes
Prenatal Diagnosis; Accepted Article

OBJECTIVES
To establish the frequency of prenatally undetected associated malformations (identified at birth) in infants with apparent “isolated” club foot deformity.

METHODS
A cohort study of all infants with unilateral or bilateral club foot deformity identified at birth among 311,480 infants surveyed between 1972 and 2012 at Brigham and Women's Hospital in Boston. Those with talipes equinovarus were divided into “isolated” and “complex”, based on the findings in examination and by chromosome analysis.

RESULTS
142 infants had “isolated” talipes equinovarus (TEV) and 66 had the “complex” type. Six (4.2%) of the 142 infants with “isolated” TEV were found at birth to have associated malformations that had not been identified by imaging during pregnancy. These abnormalities included hip dislocation (n = 2), bilateral post-axial polydactyly of the feet (n = 1), penile chordee (n = 1), and hypospadias (n = 2).

CONCLUSION
In this consecutive series of infants with isolated talipes equinovarus, 95.8% had no additional malformations identified by examination at birth. None of the additional findings were severe enough to affect the medical prognosis of the affected infant.
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NewsBot · Oct 31, 2015

TIBIAL TORSION; DOES IT DIFFER IN CHILDREN WITH CONGENITAL TALIPES EQUINOVARUS (CTEV) COMPARED TO NORMAL ONES?
Amol Sanap, Tushar Chaudhari, Binoti Sheth, Dhruvilkumar Gandhi, Kaustubh Gate, Arun AA.
IJMRHS. 2015; 4(4): 872-885doi: 10.5958/2319-5886.2015.00174.5

Background: Congenital talipes equinovarus (CTEV) or clubfoot is one of the commonest congenital orthopaedic conditions requiring intensive treatment. A typical clubfoot consists of a deformed foot in equinus ,varus, adduction. In some cases a cavus component is also there. Tibial torsion is the angle between the transverse axes of the proximal and distal tibial articular surfaces. Controversy exists concerning the presence or absence of excessive medial or internal tibial torsion in CTEV.
Materials & Methods: A cross sectional study was done of thirty consenting patients with CTEV and thirty children with injuries not involving the tibia or fibula selected by convenience sampling attending the orthopaedic clinic of a tertiary care hospital of Western Maharashtra . We measured the angular difference between the proximal and distal posterior tibial planes as defined by ultrasound scans thus minimising the error introduced by the posterior shifting of lower end fibula in the fibular notch after manipulative correction. The data was entered in excel and appropriate statistic test was applied.
Results: The mean external torsion of the tibia in children with CTEV was 18 degrees (standard deviation 2.7), which was significantly less than the mean external torsion of tibia in normal children (38.13 degrees; standard deviation 9.194) (p<0.05).
Conclusions: The children with CTEV have a relative tibial intorsion, as compared to normal children.
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NewsBot · Feb 28, 2016

Development of congenital clubfoot during growth: a long-term study on the basis of pedobarography, biomechanics, and magnetic resonance imaging measurements of muscle volumes.
Lampe R et al
J Pediatr Orthop B. 2016 Feb 25

The aim of this study was to clarify the degree to which the operated congenital asymptomatic clubfoot still shows malpositions or whether it approaches a physiological development with increasing age. Clubfeet of 12 children were examined repeatedly over up to 10 years using pedobarography. The muscle volumes of the lower legs were investigated with MRI and compared with those of a healthy control group. Although some characteristics of clubfoot remained in the plantar pressure distribution, a gradual decrease in the heel and metatarsus load accompanied by an increase in the forefoot load could be registered as is typical for a developing healthy child's foot. The MRI showed a reduced volume of all muscles of the affected lower leg. A correlation was detected between the measured moments in the upper and lower ankle joints and the volumes of the muscles that move these joints. Even though a functional and anatomical separation between the two groups existed, the general developmental changes during growth were similar. The combination of pedobarographic data and derived joint moments with MRI-measured muscle volumes indicated that higher ankle joint moments in clubfoot were associated with smaller muscle volume and were therefore generated by higher joint rigidity.
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NewsBot · Jul 5, 2016

Are incidence and severity of clubfoot related to the season of birth?
Da-Hang Zhao, Wei-Wei Rao, Li Zhao , Xuan Yang, Jian-Lin Liu, Zhen-Kai Wu, Qing Du, Xiao-Yan Yang
World Journal of Pediatrics; August 2016, Volume 12, Issue 3, pp 360-363

Background
This study was designed to determine whether the occurrence of clubfoot follows a seasonal pattern in neonates from eastern and south-eastern China and to speculate the potential etiology of clubfoot.
Methods
We reviewed 239 neonates with clubfeet during a period of 4 years as well as the monthly neonatal population of the Sixth National Population Census. Seasonal variations in terms of month of birth and severity were analyzed.
Results
The incidence of clubfoot in neonates from eastern and south-eastern China showed seasonal variations, and the incidence was higher in autumn with a reference to the average birth rate in this corresponding area. No significant difference was found in severity of clubfoot.
Conclusions
This seasonal pattern is of significant value to further understanding the etiology and pathogenesis of clubfoot in the corresponding area of China.
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NewsBot · Aug 2, 2016

Descriptive epidemiology and predisposing factors to
idiopathic talipes equinovarus in South South Nigeria
Joseph Effiong Asuquo et al
Journal of Public Health and
Epidemiology

Talipes equinovarus (Clubfoot) is the commonest foot deformity with variable incidence across races.
Exact etiology remains elusive. The objective of this study is to describe the epidemiology of clubfoot
in our centre, looking for predisposing factors. This is a descriptive clinic based epidemiologic study of
106 feet belonging to 69 subjects from January 2014 – December 2015 was conducted. Structured
questionnaires were administered to clinically confirmed clubfoot subject’s guardian or biologic
mothers. Phenotypic data from clubfoot subject were also recorded. Analysis was done using IBM
SPSS version 22 for windows. Results revealed the age range of the patients as 3 days to 9 years, with
a mean age of 46.17 ? 92.03 weeks. Thirty-seven (53.7%) patients had bilateral deformity while 13
(18.8%) patients had right-sided deformity, and 19 (27.5%) patients had left-sided deformity. Majority 40
(58.0%) of the patients were firstborn out of which 28 were males. Only 2 (2.89%) patients are products
of multiple gestations. All mothers were none smokers and there was no reported family history of foot
deformities or clubfoot. The mean maternal age was 25.81 years ? 4.99 years. The average length/height
of patients at presentation was 64.27 ? 23.93 cm. The average shoulder span of the patients at
presentation was 23.93 ? 15.86 cm. The study thus revealed that young maternal age, gender and
firstborn are predisposing factors in the etiology of clubfoot.
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NewsBot · Dec 24, 2016

Birth prevalence of Congenital Talipes Equinovarus in Low and Middle Income Countries: A Systematic Review and Meta-analysis
Tracey Smythe, et al
Tropical Medicine & International Health

Objective
Congenital talipes equinovarus (CTEV), or clubfoot, is a structural malformation that develops early in gestation. Birth prevalence of clubfoot is reported to vary both between and within low and middle-income countries (LMICs) and this information is needed in order to plan treatment services. This systematic review aims to understand the birth prevalence of clubfoot in LMIC settings.
Methods
Six databases were searched for studies that reported birth prevalence of clubfoot in LMICs. Results were screened and assessed for eligibility using pre-defined criteria. Data on birth prevalence were extracted and weighted pooled estimates were calculated for different regions. Wilcoxon rank-sum test was used to examine changes in birth prevalence over time. Included studies were appraised for their methodological quality, and a narrative synthesis of findings was conducted.
Results
48 studies provided data from 13,962,989 children in 20 countries over 55 years (1960 – 2015). The pooled estimate for clubfoot birth prevalence in LMICs within the Africa region is 1.11 (0.96, 1.26); in the Americas 1.74 (1.69,1.80); in South East Asia (excluding India) 1.21 (0.73, 1.68); in India 1.19 (0.96, 1.42); in Turkey (Europe Region) 2.03 (1.54, 2.53); in Eastern Mediterranean region 1.19 (0.98, 1.40); in West Pacific (excludes China) 0.94 (0.64, 1.24) and in China 0.51 (0.50, 0.53).
Conclusion
Birth prevalence of clubfoot varies between 0.51 and 2.03/1,000 live births in LMICs. A standardised approach to the study of the epidemiology of clubfoot is required to better understand the variations of clubfoot birth prevalence and identify possible risk factors.
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NewsBot · Jan 10, 2017

OBSERVATIONAL STUDY TO FIND ASSOCIATION BETWEEN CONGENITAL TALIPES EQUINOVARUS AND DEVELOPMENTAL DYSPLASIA OF THE HIP AND ROLE OF ULTRASOUND SCREENING
Satendra Singh Rajput, Ritesh Singh Yadav
GLOBAL JOURNAL FOR RESEARCH ANALYSIS Vol 5, No 10 (2016)

Introduction: The association between idiopathic congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip is uncertain.

Method: We present an observational cohort study spanning 6 years of selective ultrasound screening of hips in clubfoot.

Result: From 119 babies with CTEV there were nine cases of hip dysplasia, in seven individuals. This suggests that 1 in 17 babies with CTEV will have underlying hip dysplasia.

Conclusion: This study supports selective ultrasound screening of hips in infants with CTEV.
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NewsBot · Jan 28, 2017

The clubfoot over the centuries
Sanzarello, Ilaria; Nanni, Matteo; Faldini, Cesare
Journal of Pediatric Orthopaedics B: March 2017 - Volume 26 - Issue 2 - p 143–151

The aim of this paper is to review all treatment methods of the clubfoot over the years through the documentation present in the literature and art with the aim of better understanding the pathoanatomy of the deformity, but to also clarify factors that allow a safe, logical approach to clubfoot management. The initial part of this paper traces the most representative iconographic representations of clubfoot in history to describe how his presence was witnessed since ancient times. Hippocrates, the father of medicine, was the first to present written references about treatment methods of clubfoot. After the dark period of the Middle Ages, during the Renaissance, there were more detailed studies on the disease, with the creation of the first orthopedic orthotics, designed to correct the deformity with the help of famous names in medicine’s history. In the XVIII century, as we witness the birth of orthopedics as a distinct discipline in medicine, more and more brilliant minds developed complex orthoses and footwear with the aim of obtaining a proper correction of the deformity. In the last part of the paper, there is a description of the main surgical techniques developed over the years until the return to conservative treatment methods such as the Ponseti method, internationally recognized as the gold standard of treatment, despite the presence of some unresolved issues such as the possible recurrence of the disease.
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NewsBot · Feb 8, 2017

The Influence of Sex and Laterality on Clubfoot Severity
Zionts, Lewis E. MD; Jew, Michael H. BS; Ebramzadeh, Edward PhD; Sangiorgio, Sophia N. PhD
Journal of Pediatric Orthopaedics: March 2017 - Volume 37 - Issue 2 - p e129–e133

Background: Idiopathic clubfoot is bilateral in approximately 50% of cases and has been widely reported to affect males more frequently than females. Despite these observations, the correlation between sex and severity of the deformity has not been established. As well, the difference in severity between unilateral and bilateral clubfeet has not been extensively investigated. Therefore, the goals of the present study were to: (1) examine the relationship between sex and severity of deformity and (2) determine the relationship between laterality and severity of deformity.

Methods: The families of infants with idiopathic clubfoot deformity treated at our institution were prospectively invited to participate in this institutional review board–approved study. Severity of the deformity was assessed by a single surgeon for each patient using the Dimeglio criteria at the first clinic visit. After evaluating the distributions, the correlations were quantified by nonparametric analyses.

Results: Over 8 years, 240 infants met the inclusion criteria. There was no significant difference in the severity of deformity due to sex (P=0.61): the median Dimeglio score for males was 13 (variance 4.8) and for females, the median was 13.0 (variance of 5.1). In contrast, severity was distributed differently among unilateral versus bilateral patients. Although both unilateral and bilateral patients had a median Dimeglio score of 13, the ratio of bilateral patients was higher among those with moderate or very severe deformities compared with those with severe deformities (P<0.01).

Conclusions: Although idiopathic clubfoot is commonly considered to affect male patients disproportionately, this is the first study to document no difference in severity due to sex. Further, this study demonstrated that on average, bilateral patients did not have increased severity, but presented with a larger range of severity than those patients with unilateral deformity.
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NewsBot · Jul 12, 2017

Idiopathic congenital talipes equinovarus; not always an isolated anomaly. A review of long term outcomes.
Stone Pet al
J Matern Fetal Neonatal Med. 2017 Jul 10:1-13. doi: 10.1080/14767058.2017.1353967

OBJECTIVE:
To describe the long term outcomes of children at school age who were thought to have isolated idiopathic congenital talipes equino varus (ICTEV) at birth.
METHOD:
A retrospective review of all children attending a regional talipes clinic who had achieved school age.
RESULTS:
One hundred sixty three children were followed up. ICTEV was more common in Maori and other Polynesian children and in males. Additional abnormalities were apparent in 30.1% overall, but higher in New Zealand Europeans (43%) than Maori (21%) or other Polynesians (22%). Of the abnormalities, 41% were associated with the central nervous system or with neurodevelopmental delay. Conventional G-band karyotyping, where performed, was not informative.
CONCLUSION:
The rate of additional abnormalities was higher than previous reports. This has implications for prenatal counseling and postnatal follow up as a prenatal diagnosis of ICTEV may subsequently be found to have longer term implications in addition to orthopedic treatments of the clubfeet.
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NewsBot · Aug 5, 2017

Quantification of the ossification of the lateral cuneiform in the feet of young children with unilateral congenital talipes equinovarus.
Lang PJ et al
Bone Joint J. 2017 Aug;99-B(8):1109-1114. doi: 10.1302/0301-620X.99B8.BJJ-2016-0999.

AIMS:
After the initial correction of congenital talipes equinovarus (CTEV) using the Ponseti method, a subsequent dynamic deformity is often managed by transfer of the tendon of tibialis anterior (TATT) to the lateral cuneiform. Many surgeons believe the lateral cuneiform should be ossified before surgery is undertaken. This study quantifies the ossification process of the lateral cuneiform in children with CTEV between one and three years of age.
PATIENTS AND METHODS:
The length, width and height of the lateral cuneiform were measured in 43 consecutive patients with unilateral CTEV who had been treated using the Ponseti method. Measurements were taken by two independent observers on standardised anteroposterior and lateral radiographs of both feet taken at one, two and three years of age.
RESULTS:
All dimensions of the lateral cuneiform on the affected side increased annually but remained smaller than the corresponding dimensions of the unaffected foot (p < 0.01). The lateral cuneiform resembled a 9 mm cube at two years and an 11 mm cube at three years.
CONCLUSION:
At one and two years, the ossification centre of the lateral cuneiform may not be large enough to accommodate a drill hole for tendon transfer. However, by three years, it has undergone sufficient ossification to do so
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NewsBot · Feb 8, 2018

Descriptive Epidemiology of Congenital Clubfoot Deformity in Sri Lanka.
Wijayasinghe SR et al
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP [01 Feb 2018, 28(2):166-168]

A retrospective descriptive study was conducted, based on database of Sri Lanka Clubfoot Program, under theInternational Clubfoot Registry. Patients with Clubfoot deformity treated at Orthopaedic unit of Lady Ridgeway Children's Hospital (LRCH), Sri Lanka were evaluated from June 2012 to March 2015. There were a total of 354 patients with male: female ratio of 2.7:1. Bilateral deformity was detected in 48% (171) with positive family history in 14% (49). Majority was hospital births (95%) and 14% were preterm deliveries-pregnancy, and birth-related complications were found in 28.5% (101) and 11% (39), respectively. Cause of clubfoot was idiopathic in 87% (309) and syndromic in 13%. None of the mothers were smoker; three mothers have consumed alcohol during pregnancy. No significant associations among sex of the patient, laterality of clubfoot and the cause of the clubfoot, and there was no seasonal variation among births of clubfoot patients.
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NewsBot · Feb 28, 2018

Clinical profile of congenital limb anomalies in neonates
Yogesh N. Parikh, Mitul B. Kalathia, Dhanya Soodhana
Int J Contemp Pediatr. 2018 Mar;5(2):299-303

Background: Reported birth prevalence of congenital limb defects vary from country to country. Epidemiological
studies permit the timely detection of trends in congenital limb anomalies and the associations with other birth
defects. The objective of this study was to know the prevalence and the variety of congenital limb anomalies and their
association with other anomalies.
Methods: A prospective observational study in which all newborns reported to the neonatal department were
surveyed to find out the incidence, diversity and association of limb anomalies. Age of the mother, risk factors and
other demographic data of the newborns was analyzed. Babies born less than 28 weeks were excluded from the study.
Results: The prevalence was 6.34 per thousand live births. The majority of the neonates were term babies and female.
28 % of the babies were born out of consanguineous marriage. The mean age of the mother was 25. Median parity
was 1. 9.52 % of the babies had a history of anomaly in the sibling. 4.76 % had a history of still birth. The most
common congenital anomaly was congenital talipo equino varus. The other congenital limb anomalies observed were
polydactyly, syndactyly, bifid thumb and absence of the radius. There were multiple congenital anomalies in 28.57 %
of the babies.
Conclusions: The study has given us an insight into the variety of congenital limb malformations and also into the
possible etiological factors. A study done on a larger population would probably help us assess the incidence and
pattern of occurrence of limb anomalies and help us counsel the parents.
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NewsBot · Mar 9, 2018

Systematic review and meta-analysis of global birth prevalence of clubfoot: a study protocol.
Ansar A et al
BMJ Open. 2018 Mar 6;8(3):e019246. doi: 10.1136/bmjopen-2017-019246.

INTRODUCTION:
Clubfoot is a common congenital birth defect, with an average prevalence of approximately 1 per 1000 live births, although this rate is reported to vary among different countries around the world. If it remains untreated, clubfoot causes permanent disability, limits educational and employment opportunities, and personal growth. The aim of this systematic review and meta-analysis is to estimate the global birth prevalence of congenital clubfoot.

METHODS AND ANALYSIS:
Electronic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Global Health, Latin American & Caribben Health Science Literature (LILACS), Maternity and Infant Care, Web of Science, Scopus and Google Scholar will be searched for observational studies based on predefined criteria and only in English language from inception of database in 1946 to 10 November 2017. A standard data extraction form will be used to extract relevant information from included studies. The Joanna Briggs Institute appraisal checklist will be used to assess the overall quality of studies reporting prevalence. All included studies will be assessed for risk of bias using a tool developed specifically for prevalence studies. Forest plots will be created to understand the overall random effects of pooled estimates with 95% CIs. An I2 test will be done for heterogeneity of the results (P>0.05), and to identify the source of heterogeneity across studies, subgroup or meta-regression will be used to assess the contribution of each variable to the overall heterogeneity. A funnel plot will be used to identify reporting bias, and sensitivity analysis will be used to assess the impact of methodological quality, study design, sample size and the impact of missing data.

ETHICS AND DISSEMINATION:
This review will be conducted completely based on published data, so approval from an ethics committee or written consent will not be required. The results will be disseminated through a peer-reviewed publication and relevant conference presentations.
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NewsBot · Mar 27, 2018

Complex iatrogenic clubfoot: is it a real entity?
Dragoni, Massimiliano; Gabrielli, Armando; Farsetti, Pasquale; Bellini, Diego; Maglione, Pierluigi; Ippolito, Ernesto
Journal of Pediatric Orthopaedics B: March 23, 2018 - Volume Publish Ahead of Print - Issue - p

In our study, we aimed to demonstrate whether a complex iatrogenic clubfoot really exists; identify the causative mechanisms; and determine the outcome if properly treated. We observed 54 clubfeet previously treated unsuccessfully by manipulation and casting elsewhere. All the feet had been classified at diagnosis as typical clubfeet. In 26 cases, the cast had slipped down, entrapping the foot in a plantar-flexed position. Nine clubfeet out of those 26 cases presented the clinical features of a complex iatrogenic deformity. These were treated with the modified Ponseti protocol and evaluated at follow-up according to the International Clubfoot Study Group Score. The length of follow-up averaged 7.2 years. Two feet showed an excellent result, five feet showed a good result, and two feet showed a fair result. The relapse rate was 55% in complex clubfeet. Relapsed clubfeet were treated by Achilles tenotomy or lengthening and anterior tibial tendon transfer. We believe that faulty manipulation and a poor casting technique may convert a typical clubfoot into a complex iatrogenic deformity. Risk factors include severe clubfoot, short and stubby foot, and unmolded casts slipping down.
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NewsBot · May 14, 2018

Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis.
Agarwal A et al
J Orthop Surg (Hong Kong). 2018 May-Aug;26(2):23094990187723

INTRODUCTION:
Evidences suggest that different subgroups of idiopathic clubfoot exist with differences in severity and treatment outcomes. This study compares the severity and treatment outcomes of unilateral and bilateral clubfoot.

MATERIAL AND METHODS:
We retrospectively studied 161 patients (bilateral 66, unilateral 95) with primary idiopathic clubfeet to evaluate the differences in severity and treatment. The parameters analyzed were precasting Pirani score, number of casts required, pretenotomy Pirani score, pretenotomy dorsiflexion, rate of tenotomy, and post-tenotomy dorsiflexion achieved. A Pirani score of at least 5 was classified as very severe and 4.5 or less was classified as less severe.

RESULTS:
There were 49=(74.24%) male and 17 (25.75%) female patients in the bilateral group and 76 (80%) male and 19 (20%) female patients in the unilateral group. Out of 95 unilateral patients, 34 were left sided (35.8%). Comparing severity, the mean precasting Pirani score in bilateral patients (5.4 ± 0.6) was statistically more than the unilateral patients (4.9 ± 0.7). The number of casts required was significantly more in bilateral feet compared to unilateral (bilateral 5.3 ± 1.7, unilateral 4.7 ± 1.7; p < 0.011). Achilles tenotomy was required in all feet. Post Ponseti treatment, the foot deformity correction achieved (pretenotomy Pirani score, pretenotomy, and post-tenotomy dorsiflexion) was statistically similar in both unilateral and bilateral feet.

CONCLUSIONS:
Idiopathic bilateral clubfoot was more severe than unilateral foot at initial presentation and required more number of corrective casts. Post Ponseti treatment, the deformity correction in bilateral foot was similar to unilateral foot.
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NewsBot · May 19, 2018

Are we still misdiagnosing clubfoot? A study of non-clubfoot cases labeled or referred as clubfoot from primary care centers in Uttarakhand.
Dharmshaktu, G., Dar, A., & Bhandari, S.
Indian Journal of Child Health, 5(4).

Background: Clubfoot is a congenital disorder identifiable with the clinical assessment itself, provided the knowledge of key features is sound. Several disorders affecting the foot and lower limb that present with crooked or bent anatomy may be confused with it. Knowledge of common disorders that mimic clubfoot in a particular region is thus important to adequately distinguish, manage or refer the case to specialist opinion. Objectives: The current study attempts to provide an overview and documentation of the conditions referred and labeled as clubfoot from primary care facilities, the knowledge of which is important so that appropriate treatment is given to each. The findings will reflect lacunae in the knowledge and perception of primary healthcare workers regarding the deformity. Materials and Methods: A retrospective assessment of all cases referred to our dedicated clubfoot clinic with a diagnosis of clubfoot by peripheral health-care facility was done from September 2016 to October 2017. Relevant demographic details including that of parents, type of deformity, nature, laterality, and treatment received were noted for each case. Conditions requiring non-operative treatment and those requiring further evaluation were noted separately with a detailed description. Results: Out of total 97 cases labeled as clubfoot, 32 (33.68%) cases with 64 feet were part of the study after excluding true clubfoot cases. The common condition noted was calcaneovalgus, postural clubfoot, equinus deformity secondary to cerebral palsy, metatarsus adductus, in-toeing, and posteromedial bowing of tibia. Conclusion: The knowledge of common foot disorders in primary care settings should be strengthened by refresher practical training so that these disorders are diagnosed and managed there an appropriate referral is made thus leading to decrease the burden on higher centers.
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NewsBot · Jul 3, 2018

Incidence of congenital idiopathic clubfoot in the Netherlands
Besselaar, Arnold T. et al
Journal of Pediatric Orthopaedics B: June 29, 2018 - Volume Publish Ahead of Print - Issue - p

The incidence of clubfoot patients is an important factor for centralization of care. Medical records of 21 accredited clubfoot centers were selected using the diagnosis treatment codes and checked to confirm diagnosis. All idiopathic clubfoot cases born during 2013–2014 were analyzed with respect to sex, affected foot, regional distribution, and seasonal variation. Among the 346 522 live births, 377 idiopathic clubfoot cases were registered. The incidence of the congenital idiopathic clubfoot in the Netherlands during 2013 and 2014 was 1.09 per 1000 live births, indicating that every year, ~200 children with one or two clubfeet are born in the Netherlands. On the basis of this finding, we can start to refine clubfoot care.
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NewsBot · Sep 26, 2018

Incidence of congenital idiopathic clubfoot in the Netherlands
Besselaar, Arnold T.; Kamp, Maud C.; Reijman, Max; van der Steen, Marieke
Journal of Pediatric Orthopaedics B: November 2018 - Volume 27 - Issue 6 - p 563–567

The incidence of clubfoot patients is an important factor for centralization of care. Medical records of 21 accredited clubfoot centers were selected using the diagnosis treatment codes and checked to confirm diagnosis. All idiopathic clubfoot cases born during 2013–2014 were analyzed with respect to sex, affected foot, regional distribution, and seasonal variation. Among the 346 522 live births, 377 idiopathic clubfoot cases were registered. The incidence of the congenital idiopathic clubfoot in the Netherlands during 2013 and 2014 was 1.09 per 1000 live births, indicating that every year, ~200 children with one or two clubfeet are born in the Netherlands. On the basis of this finding, we can start to refine clubfoot care.
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NewsBot · Oct 2, 2018

The top 100 most-cited articles on 'Clubfoot'
AT, M., Noordin,
Journal of pediatric orthopedics. Part B, 38(9).

Clubfoot is an important aspect of pediatric orthopedics and is a readily prevalent condition presenting to orthopedic clinics worldwide. To identify landmark articles and important contributions to this field, we sought to do a citation analysis of the top 100 most-cited articles on clubfoot. Using the Scopus database and the search strategy 'Clubfoot', 'Clubfeet' OR 'Talipes Equinovarus', we identified 5753 articles. After filtering for relevant articles, the top 100 cited articles on clubfoot were retrieved for descriptive and statistical analysis. The most cited paper was 'Long-term results of treatment of congenital clubfoot' by S.J. Laaveg and I.V. Ponseti with 358 citations. The publication years ranged from 1969 to 2011. The USA was the most productive country in terms of research output, followed by the UK. Institution-wise, the University of Iowa contributed the most in terms of number of publications. The Journal of Pediatric Orthopaedics held the most number of articles. Most publications were level IV and level V studies. Although citation analysis has it flaws, this is a comprehensive list of the top 100 articles significantly affecting literature on clubfoot. On the basis our study, we conclude that there is marked deficiency of high-level articles with respect to the number of citations, and future researches need to cater to this question to produce high-quality studies
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NewsBot · Feb 19, 2019

Congenital clubfoot in Europe: A population-based study.
Wang H et al
American Journal of Medical Genetics. Part A [10 Feb 2019]

We aimed to assess prevalence, birth outcome, associated anomalies and prenatal diagnosis of congenital clubfoot in Europe using data from the EUROCAT network, and to validate the recording of congenital clubfoot as a major congenital anomaly by EUROCAT registries. Cases of congenital clubfoot were included from 18 EUROCAT registries covering more than 4.8 million births in 1995-2011. Cases without chromosomal anomalies born during 2005-2009, were randomly selected for validation using a questionnaire on diagnostic details and treatment. There was 5,458 congenital clubfoot cases of which 5,056 (93%) were liveborn infants. Total prevalence of congenital clubfoot was 1.13 per 1,000 births (95% CI 1.10-1.16). Prevalence of congenital clubfoot without chromosomal anomaly was 1.08 per 1,000 births (95% CI 1.05-1.11) and prevalence of isolated congenital clubfoot was 0.92 per 1,000 births (95% CI 0.90-0.95), both with decreasing trends over time and large variations in prevalence by registry. The majority of cases were isolated congenital clubfoot (82%) and 11% had associated major congenital anomalies. Prenatal detection rate of isolated congenital clubfoot was 22% and increased over time. Among 301 validated congenital clubfoot cases, diagnosis was confirmed for 286 (95%). In conclusion, this large population-based study found a decreasing trend of congenital clubfoot in Europe after 1999-2002, an increasing prenatal detection rate, and a high standard of coding of congenital clubfoot in EUROCAT.
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NewsBot · Jul 24, 2019

Does laterality of deformity influence the severity of the idiopathic clubfoot?
C.O. Anisi, I.E. Abang, J.E. Asuquo, P.U. Agweye, O.G. Osakwe
Nigerian Journal of Medicine

Background: The idiopathic clubfoot has been widely reported as the commonest congenital deformity of the lower limbs with incidence of approximately 1-2 in 1000 live births. Its exact aetiology is not known. The deformity is bilateral in more than half of the cases. This study was designed to compare the severity of bilateral and unilateral idiopathic clubfoot, and to determine if there is any correlation between the left and right feet of bilateral cases.

Methods: Records of all patients with idiopathic clubfoot who presented at our clubfoot clinic between January 2013 and November 2018 were reviewed. Patients were categorized into two groups, the 'Bilateral Idiopathic Clubfoot' and 'Unilateral Idiopathic Clubfoot' groups. The degree of deformity of each affected foot was categorized based on the Pirani score at presentation as 'Less Severe' for scores less than or equal to 4.0. Statistical analysis and tests for associations and correlation between variables were done using IBM SPSS version 22.0.

Result: Records of 185 idiopathic clubfoot cases belonging to 120 (65 bilateral, 55 unilateral) patients who met the inclusion criteria were studied. The age range of the patients at presentation was 3 days to 24 months. The degree of deformity was proportionately more severe in the 'Bilateral Idiopathic Clubfoot' group compared to the 'Unilateral Idiopathic Clubfoot' group (p<0.0001). The left and right feet of the bilateral cases were highly correlated (r=0.861, p<0.0001).

Conclusion: Bilateral idiopathic clubfoot cases were more severely deformed than unilateral idiopathic clubfoot cases. Left and right feet of bilateral cases were highly correlated.
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NewsBot · Aug 7, 2019

The Idiopathic Clubfoot: Relationship between
Patient’s Gender and the Degree of Severity of
the Deformity
Chukwuemeka Okechukwu Anisi et al
Asian Journal of Orthopaedic Research

Background: The prevalence of the idiopathic clubfoot has been largely reported to be higher in
male patients. However, the existence of any relationship between the gender of patients and the
degree of severity of the deformity is yet to be established. This study was designed to determine if
there is any relationship between the gender of idiopathic clubfoot patients and the degree of
severity of deformity.
Methods: Records of all idiopathic clubfoot patients aged 2 years and below who presented at the
clubfoot clinic of the University of Calabar Teaching Hospital between January 2013 and March
2019 were reviewed. The degree of deformity of each affected foot based on the ascribed Pirani
score at presentation was graded as ‘Less Severe’ for scores less than or equal to 4.0, and ‘More
Severe’ for scores greater than 4.0. For the purpose of data analysis, patients were categorized
into 2 groups, ‘Male Idiopathic Clubfoot’ and ‘Female Idiopathic Clubfoot’ groups. Statistical
analysis was done using IBM SPSS version 22.0.
Results: Median total Pirani score and mean total Pirani score were higher for male patients. The
degree of severity of deformity for unilateral cases was evenly distributed irrespective of gender,
while for bilateral cases, the degree of severity was proportionately more severe for male patients,
and evenly distributed for female patients (p=0.514).
Conclusion: In this study, the researchers did not find any significant relationship between gender
and the degree of severity of the idiopathic clubfoot.
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Paralytic congenital talipes equinovarus

Interventions for congenital talipes equinovarus (clubfoot).

talipes equinovarus in a 20 year old

Talipes?neuroma/bursitis

Corrective surgery for talipes, in adulthood

Talipes equino varus in an adult

12 yo talipes pt

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