Clubfoot, or talipes equinovarus, is a treatable birth defect where one or both feet are rotated inward and downward that affects approximately 150,000-200,000 children each year.

The affected foot and leg may be smaller in size compared to the other. Approximately 50% of cases of clubfoot affect both feet. Most of the time, it is not associated with other problems. Without treatment, the foot remains deformed, and people walk on the sides of their feet. This may lead to pain and difficulty walking. The exact cause is usually not identified. Both genetic and environmental factors are believed to be involved. If one identical twin is affected, there is a 33% chance the other one will be as well. The underlying mechanism involves disruption of the muscles or connective tissue of the lower leg, leading to joint contracture. Other abnormalities are associated 20% of the time, with the most common being distal arthrogryposis and myelomeningocele. The diagnosis may be made at birth by examination or before birth during an ultrasound exam.

Initial treatment is most often with the Ponseti method. This involves moving the foot into an improved position followed by casting, which is repeated at weekly intervals. Once the inward bending is improved, the Achilles tendon is often cut, and braces are worn until the age of four. Initially, the brace is worn nearly continuously and then just at night. In about 20% of cases, further surgery is required. Treatment can be carried out by a range of healthcare providers and can generally be achieved in the developing world with few resources. Clubfoot occurs in 1 to 4 of every 1,000 live births, making it one of the most common birth defects affecting the legs. About 80% of cases occur in developing countries where there is limited access to care. Clubfoot is more common in firstborn children and males. It is more common among Māori people, and less common among Chinese people.

Links:
World Clubfoot Day