Talipes equinovarus, the Latin term for clubfoot, is the most prevalent congenital musculoskeletal anomaly worldwide, affecting approximately 1 in 1,000 newborns. A majority of clubfoot burden impacts low and middle-income countries, underscoring the global health disparities in access to early intervention. If left untreated, this condition can lead to significant deformities, emphasizing the critical role pediatricians play in timely diagnosis, management, and treatment of clubfoot.
80% of cases are isolated idiopathic clubfoot, while a minority are associated with syndromes or neurogenic conditions such as spina bifida, trisomy 18, and arthrogryposis. Males are twice as likely to be affected, and a positive family history may hint at a genetic component. Prenatal ultrasound has become a crucial tool in diagnosing clubfoot, however, some cases are not identified until the newborn physical examination.
The distinctive characteristics of clubfoot encompass the CAVE mnemonic:
- Cavus of midfoot (high arch)
- Adducted forefoot (foot turned in)
- Varus of the hindfoot (turning in of heel)
- Equinus of hindfoot (hindfoot pointing downward)
In addition to these characteristics, the affected foot tends to be smaller, and the calf appears skinnier. Furthermore, the foot and ankle exhibit stiffness that resists correction by manual manipulation.
Clubfoot is a condition that demands our expertise, compassion, and collaborative efforts with pediatric orthopedics to ensure every tiny step leads to a future filled with mobility for our little patients.
Hear more about how the rest of the physical exam, workup, and clinical course plays out on this month's Peds RAP segment!
