Saturday, July 5, 2008


What is Clubfoot?
Clubfoot, or talipes equinovarus, is a treatable birth defect that affects approximately 150,000-200,000 children each year. When clubfoot occurs the foot is twisted inward and down, and this condition occurs during development in the womb. Physicians have observed that fetuses that develop clubfoot start with a normal foot and then the foot begins to turn inward around the third month. Most children born with clubfoot are not missing any bones, muscles, or connective tissue. It is a congenital condition, meaning that when it occurs it is always present at birth. It is one of the most common congenital deformities. One or both feet may be affected and the affected feet can range from relatively flexible to stiff and rigid. The condition is not painful for the new born, though when a child gets to walking age, walking with an uncorrected clubfoot can be very painful and difficult, if not impossible.

When will you know?
Parents will know at birth if their child has clubfoot because the foot will be twisted inward. Some cases are diagnosed during a routine ultrasound. If you are wondering if your child has clubfoot, contact a physician who has experience in diagnosing this condition (not all pediatricians know how to diagnose clubfoot).

Malaysia's fact (shared by Prof Sharaf of HUKM)
Boo NY, Ong LC.
Department of Pediatrics, Faculty of Medicine, National University of Malaysia.

A study was carried out on 8,369 neonates delivered in the Maternity Hospital, Kuala Lumpur over a period of four months. Forty-nine neonates (5.6 per 1000 livebirths) had congenital talipes. The incidence of congenital talipes equinovarus (CTEV) was 4.5 per 1000 livebirths while that of congenital talipes calcaneovalgus (CTCV) was 1.3 per 1000 livebirths. 6/11 (54.5%) of the CTCV was unilateral, the ratio of right to left feet involvement being 1:1. Only 12/38 (31.5%) of the CTEV were unilateral, the ratio of right to left feet involvement being 1:2. Congenital talipes was significantly more common in the low birthweight neonates (p less than 0.001). However, the condition was not significantly more common in neonates with breech presentation nor in those born to primigravida mothers. Our data suggested that multifactorial genetic background as the most likely underlying cause of congenital talipes in Malaysian neonates.

Residual deformity following surgical treatment of congenital talipes equinovarus.
Simbak N, Razak M.
Universiti Sains Malaysia, Kelantan
A study was carried out on 24 patients (36 clubfeet) surgically treated at the Orthopaedic Department National University of Malaysia, Kuala Lumpur, over a period of four and half years. Nine feet underwent posterior release, 24 feet underwent posteromedial release combined with Evan's procedure. The overall operative result was 63.3% good, 9.5% fairly and 27.2% poor. Patients who underwent surgery between 3 to 12 months showed a high percentage of good results (66.7%). Metatarsal adduction was found to be the commonest residual deformity (63.9%), followed by heel varus (11.1%), cavus (11.1%) and equinus (5.6%). Inadequacy of primary surgery and post operative period of immobilization resulted in a significant high failure rate.

What does Dr Ponseti thinks on the surgery?
Ignacio Ponseti, MDDepartment of Orthopaedic Surgery, University of Iowa Hospitals and Clinics
Surgery does not "cure" clubfoot. It improves the appearance of the foot but diminished the strength of the muscles in the foot and leg, causes stiffness in the second and third decade of life, if not earlier, limits the motions of the foot joints, and the foot becomes often painful at midlife. Surgery does not prevent the recurrence of the deformity in a number of cases. To my knowledge not followup studies of operated patients older than 16 years of age has been published to date. Therefore, orthopaedic surgeons are ignorant of the results of their surgeries.
Foot and ankle surgeons, however, who treat adult patients have noticed that those surgically treated for congenital clubfoot in infancy have weak, stiff and often very painful feet.

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