Materiały źródłowe

• #1 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8339820/

  Several studies have described the pathology of idiopathic congenital clubfoot (ICCF) in fetus. Numerous pathogenetic theories have been postulated on ICCF, but many of them lack any objective evidence. Pathologic studies in fetus together with MRI studies in patients with ICCF seem to favor the theory of a muscular imbalance of the foot activators during fetal growth as the main pathogenetic factor of ICCF. […] The authors postulate that a defect of both the radial and the longitudinal growth unevenly affecting the leg muscles with a consequent imbalance of the foot activators might be the main pathogenetic factor of ICCF. Further studies are needed to confirm this theory. […] Many pathogenetic theories have been postulated in ICCF, but some of them have been based on assumptions lacking any objective evidence.

• #2 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://atm.amegroups.org/article/view/66832/html

  Several studies have described the pathology of idiopathic congenital clubfoot (ICCF) in fetus. Numerous pathogenetic theories have been postulated on ICCF, but many of them lack any objective evidence. Pathologic studies in fetus together with MRI studies in patients with ICCF seem to favor the theory of a muscular imbalance of the foot activators during fetal growth as the main pathogenetic factor of ICCF. […] The authors postulate that a defect of both the radial and the longitudinal growth unevenly affecting the leg muscles with a consequent imbalance of the foot activators might be the main pathogenetic factor of ICCF. Further studies are needed to confirm this theory. […] Many pathogenetic theories have been postulated in ICCF, but some of them have been based on assumptions lacking any objective evidence.

• #3 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8339820/

  The theory of muscle imbalance caused by a non-neurologic etiologic factor that impaired muscle growth was first proposed by Bechtol and Mossman, who dissected the unilateral ICCF of a 12-week-old fetus in which the foot deformity was caused only by the subluxation of the tarsal joints without any deformity of the tarsal bones. […] The combined traction of both triceps surae and tibialis posterior muscles may bring the foot into extreme inversion, i.e., in equinus and varus of the hindfoot and cavus, supination and adduction of the mid-forefoot. […] A preliminary histochemical study has shown a decrease of some muscle growth factors and the presence of myostatin that inhibits muscle growth in the soleus of children with ICCF, thus supporting our theory of impaired muscle growth.

• #4 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://atm.amegroups.org/article/view/66832/html

  A theory of retracting fibrosis involving the soft tissues of the posteromedial aspect of the leg and foot has been supported by the histologic observation of increased fibrous tissue within the ligaments, fasciae muscles and tendon sheaths. […] Dietz postulated the theory of a regional growth disorder, supported by two clinical observations. First, the leg and foot are smaller than normal in ICCF—the reduction of foot and leg size being more marked in severe deformities—and second, relapse in a corrected clubfoot occurs during the rapid growth period of the foot. […] The theory of muscle imbalance caused by a non-neurologic etiologic factor that impaired muscle growth was first proposed by Bechtol and Mossman, who dissected the unilateral ICCF of a 12-week-old fetus in which the foot deformity was caused only by the subluxation of the tarsal joints without any deformity of the tarsal bones.

• #5 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8339820/

  The theory of muscle imbalance caused by a non-neurologic etiologic factor that impaired muscle growth was first proposed by Bechtol and Mossman, who dissected the unilateral ICCF of a 12-week-old fetus in which the foot deformity was caused only by the subluxation of the tarsal joints without any deformity of the tarsal bones. […] The combined traction of both triceps surae and tibialis posterior muscles may bring the foot into extreme inversion, i.e., in equinus and varus of the hindfoot and cavus, supination and adduction of the mid-forefoot. […] A preliminary histochemical study has shown a decrease of some muscle growth factors and the presence of myostatin that inhibits muscle growth in the soleus of children with ICCF, thus supporting our theory of impaired muscle growth.

• #6 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8339820/

  The theory of muscle imbalance caused by a non-neurologic etiologic factor that impaired muscle growth was first proposed by Bechtol and Mossman, who dissected the unilateral ICCF of a 12-week-old fetus in which the foot deformity was caused only by the subluxation of the tarsal joints without any deformity of the tarsal bones. […] The combined traction of both triceps surae and tibialis posterior muscles may bring the foot into extreme inversion, i.e., in equinus and varus of the hindfoot and cavus, supination and adduction of the mid-forefoot. […] A preliminary histochemical study has shown a decrease of some muscle growth factors and the presence of myostatin that inhibits muscle growth in the soleus of children with ICCF, thus supporting our theory of impaired muscle growth.

• #7 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://atm.amegroups.org/article/view/66832/html

  This theory was later shared by other authors who reported atrophy and shortening of the leg muscles in fetuses affected by unilateral ICCF, mostly involving the posteromedial compartment of the leg. […] A preliminary histochemical study has shown a decrease of some muscle growth factors and the presence of myostatin that inhibits muscle growth in the soleus of children with ICCF, thus supporting our theory of impaired muscle growth.

• #8 Foot deformities – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/foot-deformities/

  Dominant medial musculature; posterior tibial muscle is considered to be the muscle primarily responsible for the clubfoot (plantar flexion and supination, particularly of the hindfoot) […] Weak peroneus muscles […] Shortened Achilles tendon […] Pathogenesis: idiopathic; repetitive microtrauma of the tendon insertion has been suggested as an underlying cause.

• #9 Foot deformities – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/foot-deformities/

  Dominant medial musculature; posterior tibial muscle is considered to be the muscle primarily responsible for the clubfoot (plantar flexion and supination, particularly of the hindfoot) […] Weak peroneus muscles […] Shortened Achilles tendon […] Pathogenesis: idiopathic; repetitive microtrauma of the tendon insertion has been suggested as an underlying cause.

• #10 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://atm.amegroups.org/article/view/66832/html

  A theory of retracting fibrosis involving the soft tissues of the posteromedial aspect of the leg and foot has been supported by the histologic observation of increased fibrous tissue within the ligaments, fasciae muscles and tendon sheaths. […] Dietz postulated the theory of a regional growth disorder, supported by two clinical observations. First, the leg and foot are smaller than normal in ICCF—the reduction of foot and leg size being more marked in severe deformities—and second, relapse in a corrected clubfoot occurs during the rapid growth period of the foot. […] The theory of muscle imbalance caused by a non-neurologic etiologic factor that impaired muscle growth was first proposed by Bechtol and Mossman, who dissected the unilateral ICCF of a 12-week-old fetus in which the foot deformity was caused only by the subluxation of the tarsal joints without any deformity of the tarsal bones.

• #11 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  Various theories of the pathogenesis of clubfeet have been advanced, including the following: […] With respect to neurogenic factors, histochemical abnormalities have been found in posteromedial and peroneal muscle groups of patients with clubfeet. This is postulated to be due to innervation changes in intrauterine life secondary to a neurologic event, such as a stroke leading to mild hemiparesis or paraparesis. This is further supported by a 35% incidence of varus and equinovarus deformity in spina bifida. […] Retracting fibrosis (or myofibrosis) may occur secondary to increased fibrous tissue in muscles and ligaments. In fetal and cadaveric studies, Ponseti also found the collagen in all of the ligamentous and tendinous structures (except the Achilles [calcaneal] tendon), and it was very loosely crimped and could be stretched.

• #12 Clubfoot – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551574/

  The talus is characteristically medially deviated and in plantarflexion, while the calcaneus is in varus and is rotated medially around the talus. The navicular and the cuboid are displaced medially. […] Histologically clubfeet have evidence of abnormally dense collagen fibers in structures medially and posteriorly. This condition predominantly affects the Achilles tendon, tibialis posterior, the tibionavicular, and calcaneonavicular ligaments.

• #13 SciELO Brazil – Pé torto congênito Pé torto congênito

  https://www.scielo.br/j/aob/a/WVjrRdz7zfrxPWwkpjFK8mR/?lang=en

  The discovery of the existence of fibrotic tissue in the muscles, fasciae, ligaments and tendon sheaths of the posteromedial region of the ankle and hindfoot corroborates the hypothesis of primary defect of soft parts and neuromuscular units that lead to bone alterations. […] Shortening, fibrosis and retraction of the muscles and ligaments in CC are said to be genetically induced, resulting in abnormal retraction capacity that could possibly be related to primary congenital deformities and also to relapses that occur, even after adequate treatment. […] Genetic factors may be involved in the origin of CC as suggested by studies that evidenced an increase in family incidence and in identical twins. […] The consensus concerning the true genetic inheritance pattern has not yet been established, but a multifactorial polygenic inheritance pattern that can be influenced by external factors is suggested, with incomplete dominance and variable penetrance.

• #14 Clubfoot – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551574/

  Clubfoot is a congenital deformity of the foot, otherwise known as congenital talipes equinovarus. It is one of the most common congenital malformations and is characterized across varying degrees and severity of predictable contractures manifesting with four main components: midfoot cavus, forefoot adductus, heel/hindfoot varus and hindfoot equinus. […] Although the exact etiology remains debated, the consensus favors multiple genetic and environmental risk factors that play varying levels of contributing roles in its clinical manifestations. Environmental factors such as maternal smoking and maternal diabetes have the strongest association with clubfoot. […] In clubfoot, the deformity predominantly exists in the tarsal bones, which are often in a position of maximal flexion and adduction. Clubfoot presentations vary from mild, postural forms to severe, rigid deformity.

• #15 Clubfoot – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551574/

  The talus is characteristically medially deviated and in plantarflexion, while the calcaneus is in varus and is rotated medially around the talus. The navicular and the cuboid are displaced medially. […] Histologically clubfeet have evidence of abnormally dense collagen fibers in structures medially and posteriorly. This condition predominantly affects the Achilles tendon, tibialis posterior, the tibionavicular, and calcaneonavicular ligaments.

• #16 Clubfoot in children: An overview | The Foot and Ankle Online Journal

  http://faoj.org/2020/12/31/clubfoot-in-children-an-overview/

  Scarpa mentioned that the osseous defects in the talus are the primary causative factor in pathogenesis of the clubfoot. […] Other authors postulated that the calcaneus is the primary fault in pathogenesis of clubfoot attributing their suggestion to the ossification of the calcaneus that noticed to appear before that of talus. […] The anatomical deviations are summarized by the 4 letters of the word “cave” (C=Cavus, A=Adduction, V=Varus and E=Equinus). […] The main features include the followings: 1- Cavus: It is the increased convexity (or longitudinal arch) of the foot. […] 2- Adduction: The forefoot is adducted. […] 3- Varus: It is the inversion and adduction of the hindfoot. […] 4- Equinus: The entire foot shows an increased plantar flexion at the ankle joint. […] The soft structures on the medial and posterior aspects of the foot are shortened and thickened keeping the position of the foot in adduction and varus with equinus respectively.

• #17 Clubfoot in children: An overview | The Foot and Ankle Online Journal

  http://faoj.org/2020/12/31/clubfoot-in-children-an-overview/

  Scarpa mentioned that the osseous defects in the talus are the primary causative factor in pathogenesis of the clubfoot. […] Other authors postulated that the calcaneus is the primary fault in pathogenesis of clubfoot attributing their suggestion to the ossification of the calcaneus that noticed to appear before that of talus. […] The anatomical deviations are summarized by the 4 letters of the word “cave” (C=Cavus, A=Adduction, V=Varus and E=Equinus). […] The main features include the followings: 1- Cavus: It is the increased convexity (or longitudinal arch) of the foot. […] 2- Adduction: The forefoot is adducted. […] 3- Varus: It is the inversion and adduction of the hindfoot. […] 4- Equinus: The entire foot shows an increased plantar flexion at the ankle joint. […] The soft structures on the medial and posterior aspects of the foot are shortened and thickened keeping the position of the foot in adduction and varus with equinus respectively.

• #18 SciELO Brazil – Pé torto congênito Pé torto congênito

  https://www.scielo.br/j/aob/a/WVjrRdz7zfrxPWwkpjFK8mR/?lang=en

  Three-dimensional bone connectivity is altered in a complex manner and, according to Ponseti, the most severe deformities are located in the hindfoot, where the talus and the calcaneus are in accentuated equinus, the calcaneus is positioned medially and angulated in varus, and the navicular exhibits accentuated medial deviation. […] The talus presents morphological malformation, and the neck is angulated medially and plantarly, in comparison to a normal foot. […] Moreover, in CC, the calf muscles are smaller, the foot size, as a whole, and that of the bones, individually, is also smaller. […] Vascular malformations were described in CC whose origin can be congenital, or otherwise adaptive to severe and prolonged deformity.

• #19 Orthopedics and Rheumatology open access journal (OROAJ)

  https://juniperpublishers.com/oroaj/OROAJ.MS.ID.555728.php

  Club foot tends to be familial in a significant number of cases. Wynne Davis supported the polygenic theory and showed a rapid decrease in the incidence of clubfoot from first to second to third-degree relatives. About 2.9% of siblings in the first-degree relatives had this deformity as compared to 1-2 per thousand masses and chances of getting affected in siblings are more than 25 times. […] A normal developing foot turns into a clubfoot during the second trimester of pregnancy. Clubfoot is not an embryonic abnormality. Treating successfully clubfoot and understanding the pathomechanics has always been an unsolved point for modern medicine. […] The Ponseti method is a specific method of casting, serial manipulation, and surgery of cutting down the Achilles tendon i.e. tenotomy. Treatment is provided instantly after birth and leads to plaster casting and serial manipulation. […] If the manipulation or serial casting treatment fails, surgery is required. The surgical correction is usually not done until the child is between six and nine months of age. Surgical treatment is performed to correct clubfoot and align the foot in the original position.

• #20 Orthopedics and Rheumatology open access journal (OROAJ)

  https://juniperpublishers.com/oroaj/OROAJ.MS.ID.555728.php

  Club foot tends to be familial in a significant number of cases. Wynne Davis supported the polygenic theory and showed a rapid decrease in the incidence of clubfoot from first to second to third-degree relatives. About 2.9% of siblings in the first-degree relatives had this deformity as compared to 1-2 per thousand masses and chances of getting affected in siblings are more than 25 times. […] A normal developing foot turns into a clubfoot during the second trimester of pregnancy. Clubfoot is not an embryonic abnormality. Treating successfully clubfoot and understanding the pathomechanics has always been an unsolved point for modern medicine. […] The Ponseti method is a specific method of casting, serial manipulation, and surgery of cutting down the Achilles tendon i.e. tenotomy. Treatment is provided instantly after birth and leads to plaster casting and serial manipulation. […] If the manipulation or serial casting treatment fails, surgery is required. The surgical correction is usually not done until the child is between six and nine months of age. Surgical treatment is performed to correct clubfoot and align the foot in the original position.

• #21 The etiology of idiopathic congenital talipes equinovarus: a systematic review | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-0913-z

  Even though the role of environmental factors has been confirmed by several studies, all the proposed factors except for smoking were not significantly associated with ICTEV, which was linked to DNA oxidative damage caused by tobacco smoking. […] Genetics has a crucial role in the development of ICTEV, even though no major gene candidate has been identified. […] There is evidence of a family history of TEV in 2450% of cases. […] Many different families of genes were identified to play a role in the disease and a prospective role in the development of personalized conservative and surgical approaches. […] The homeobox genes represent a family of transcription factors that play a central role in the morphogenesis processes of embryonic development. […] Several candidate gene studies found a locus of genetic susceptibility associated with ICTEV in the HOX domain and the caspase domain.

• #22 The etiology of idiopathic congenital talipes equinovarus: a systematic review | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-0913-z

  Even though the role of environmental factors has been confirmed by several studies, all the proposed factors except for smoking were not significantly associated with ICTEV, which was linked to DNA oxidative damage caused by tobacco smoking. […] Genetics has a crucial role in the development of ICTEV, even though no major gene candidate has been identified. […] There is evidence of a family history of TEV in 2450% of cases. […] Many different families of genes were identified to play a role in the disease and a prospective role in the development of personalized conservative and surgical approaches. […] The homeobox genes represent a family of transcription factors that play a central role in the morphogenesis processes of embryonic development. […] Several candidate gene studies found a locus of genetic susceptibility associated with ICTEV in the HOX domain and the caspase domain.

• #23 The etiology of idiopathic congenital talipes equinovarus: a systematic review | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-0913-z

  Even though the role of environmental factors has been confirmed by several studies, all the proposed factors except for smoking were not significantly associated with ICTEV, which was linked to DNA oxidative damage caused by tobacco smoking. […] Genetics has a crucial role in the development of ICTEV, even though no major gene candidate has been identified. […] There is evidence of a family history of TEV in 2450% of cases. […] Many different families of genes were identified to play a role in the disease and a prospective role in the development of personalized conservative and surgical approaches. […] The homeobox genes represent a family of transcription factors that play a central role in the morphogenesis processes of embryonic development. […] Several candidate gene studies found a locus of genetic susceptibility associated with ICTEV in the HOX domain and the caspase domain.

• #24 The etiology of idiopathic congenital talipes equinovarus: a systematic review | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-0913-z

  Even though the role of environmental factors has been confirmed by several studies, all the proposed factors except for smoking were not significantly associated with ICTEV, which was linked to DNA oxidative damage caused by tobacco smoking. […] Genetics has a crucial role in the development of ICTEV, even though no major gene candidate has been identified. […] There is evidence of a family history of TEV in 2450% of cases. […] Many different families of genes were identified to play a role in the disease and a prospective role in the development of personalized conservative and surgical approaches. […] The homeobox genes represent a family of transcription factors that play a central role in the morphogenesis processes of embryonic development. […] Several candidate gene studies found a locus of genetic susceptibility associated with ICTEV in the HOX domain and the caspase domain.

• #25 Clubfoot – Wikipedia

  https://en.wikipedia.org/wiki/Clubfoot

  The theory of fetal growth arrest was proposed by Von Volkmann in 1863, and has been verified by other authors since. According to this theory, intrinsic errors or environmental insults during gestation prevents the correction of an equinovarus to pronated foot. Other researchers hypothesize that clubfoot may derive from external insults during gestation. […] Mutations in genes involved in muscle development are risk factors for clubfoot, specifically those encoding the muscle contractile complex. Genetic mapping and the development of models of the disease have improved understanding of developmental processes. Its inheritance pattern is explained as a heterogenous disorder using a polygenic threshold model. The PITX1-TBX4 transcriptional pathway has become key to the study of clubfoot.

• #26 Clubfoot – Wikipedia

  https://en.wikipedia.org/wiki/Clubfoot

  The theory of fetal growth arrest was proposed by Von Volkmann in 1863, and has been verified by other authors since. According to this theory, intrinsic errors or environmental insults during gestation prevents the correction of an equinovarus to pronated foot. Other researchers hypothesize that clubfoot may derive from external insults during gestation. […] Mutations in genes involved in muscle development are risk factors for clubfoot, specifically those encoding the muscle contractile complex. Genetic mapping and the development of models of the disease have improved understanding of developmental processes. Its inheritance pattern is explained as a heterogenous disorder using a polygenic threshold model. The PITX1-TBX4 transcriptional pathway has become key to the study of clubfoot.

• #27 Clubfoot – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551574/

  Clubfoot is a congenital deformity of the foot, otherwise known as congenital talipes equinovarus. It is one of the most common congenital malformations and is characterized across varying degrees and severity of predictable contractures manifesting with four main components: midfoot cavus, forefoot adductus, heel/hindfoot varus and hindfoot equinus. […] Although the exact etiology remains debated, the consensus favors multiple genetic and environmental risk factors that play varying levels of contributing roles in its clinical manifestations. Environmental factors such as maternal smoking and maternal diabetes have the strongest association with clubfoot. […] In clubfoot, the deformity predominantly exists in the tarsal bones, which are often in a position of maximal flexion and adduction. Clubfoot presentations vary from mild, postural forms to severe, rigid deformity.

• #28 The Incidence of Clubfoot in the Czech Republic: A Nationwide Epidemiological Study from 2000 to 2014

  https://www.mdpi.com/2227-9067/10/4/714

  Clubfoot (CF), also known as congenital talipes equinovarus (CTEV), is one of the most common musculoskeletal birth deformities, with a prevalence of between 0.6 and 6.8 per 1000 live births. […] The etiology of CF remains unclear, but there is convincing evidence for a multifactorial etiologic model involving both genetic and environmental factors. […] The discovery that mutations in the PITX1-TBX4-HOXC transcriptional pathway cause familial CF and vertical talus in a small number of families has provided new insights into the pathogenesis of CF. […] Environmental factors may play a role in the etiology of clubfoot too. […] The study by Honein et al. reported a relationship between smoking and clubfoot with an adjusted odds ratio of 1.34 for smoking only, 6.52 for a family history only, and 20.30 for combined exposure to smoking and family.

• #29 Clubfoot in children: An overview | The Foot and Ankle Online Journal

  http://faoj.org/2020/12/31/clubfoot-in-children-an-overview/

  Scarpa mentioned that the osseous defects in the talus are the primary causative factor in pathogenesis of the clubfoot. […] Other authors postulated that the calcaneus is the primary fault in pathogenesis of clubfoot attributing their suggestion to the ossification of the calcaneus that noticed to appear before that of talus. […] The anatomical deviations are summarized by the 4 letters of the word “cave” (C=Cavus, A=Adduction, V=Varus and E=Equinus). […] The main features include the followings: 1- Cavus: It is the increased convexity (or longitudinal arch) of the foot. […] 2- Adduction: The forefoot is adducted. […] 3- Varus: It is the inversion and adduction of the hindfoot. […] 4- Equinus: The entire foot shows an increased plantar flexion at the ankle joint. […] The soft structures on the medial and posterior aspects of the foot are shortened and thickened keeping the position of the foot in adduction and varus with equinus respectively.

• #30 clubfoot | The Foot and Ankle Online Journal

  http://faoj.org/tag/clubfoot/

  In clubfoot, there is a complex musculoskeletal alteration in the foot to be directed down and medially resembling the club used to hit the golf ball. […] The anatomical deviations are summarized by the 4 letters of the word “cave” (C=Cavus, A=Adduction, V=Varus and E=Equinus). […] The main features include the followings: Cavus: It is the increased convexity (or longitudinal arch) of the foot. […] Adduction: The forefoot is adducted. […] Varus: It is the inversion and adduction of the hindfoot. […] Equinus: The entire foot shows an increased plantar flexion at the ankle joint. […] The soft structures on the medial and posterior aspects of the foot are shortened and thickened keeping the position of the foot in adduction and varus with equinus respectively. […] The joints of the foot are distorted due to malposition of its bones.

• #31 Clubfoot in children: An overview | The Foot and Ankle Online Journal

  http://faoj.org/2020/12/31/clubfoot-in-children-an-overview/

  Scarpa mentioned that the osseous defects in the talus are the primary causative factor in pathogenesis of the clubfoot. […] Other authors postulated that the calcaneus is the primary fault in pathogenesis of clubfoot attributing their suggestion to the ossification of the calcaneus that noticed to appear before that of talus. […] The anatomical deviations are summarized by the 4 letters of the word “cave” (C=Cavus, A=Adduction, V=Varus and E=Equinus). […] The main features include the followings: 1- Cavus: It is the increased convexity (or longitudinal arch) of the foot. […] 2- Adduction: The forefoot is adducted. […] 3- Varus: It is the inversion and adduction of the hindfoot. […] 4- Equinus: The entire foot shows an increased plantar flexion at the ankle joint. […] The soft structures on the medial and posterior aspects of the foot are shortened and thickened keeping the position of the foot in adduction and varus with equinus respectively.

• #32 clubfoot | The Foot and Ankle Online Journal

  http://faoj.org/tag/clubfoot/

  In clubfoot, there is a complex musculoskeletal alteration in the foot to be directed down and medially resembling the club used to hit the golf ball. […] The anatomical deviations are summarized by the 4 letters of the word “cave” (C=Cavus, A=Adduction, V=Varus and E=Equinus). […] The main features include the followings: Cavus: It is the increased convexity (or longitudinal arch) of the foot. […] Adduction: The forefoot is adducted. […] Varus: It is the inversion and adduction of the hindfoot. […] Equinus: The entire foot shows an increased plantar flexion at the ankle joint. […] The soft structures on the medial and posterior aspects of the foot are shortened and thickened keeping the position of the foot in adduction and varus with equinus respectively. […] The joints of the foot are distorted due to malposition of its bones.

• #33 clubfoot | The Foot and Ankle Online Journal

  http://faoj.org/tag/clubfoot/

  In clubfoot, there is a complex musculoskeletal alteration in the foot to be directed down and medially resembling the club used to hit the golf ball. […] The anatomical deviations are summarized by the 4 letters of the word “cave” (C=Cavus, A=Adduction, V=Varus and E=Equinus). […] The main features include the followings: Cavus: It is the increased convexity (or longitudinal arch) of the foot. […] Adduction: The forefoot is adducted. […] Varus: It is the inversion and adduction of the hindfoot. […] Equinus: The entire foot shows an increased plantar flexion at the ankle joint. […] The soft structures on the medial and posterior aspects of the foot are shortened and thickened keeping the position of the foot in adduction and varus with equinus respectively. […] The joints of the foot are distorted due to malposition of its bones.

• #34 clubfoot | The Foot and Ankle Online Journal

  http://faoj.org/tag/clubfoot/

  In clubfoot, there is a complex musculoskeletal alteration in the foot to be directed down and medially resembling the club used to hit the golf ball. […] The anatomical deviations are summarized by the 4 letters of the word “cave” (C=Cavus, A=Adduction, V=Varus and E=Equinus). […] The main features include the followings: Cavus: It is the increased convexity (or longitudinal arch) of the foot. […] Adduction: The forefoot is adducted. […] Varus: It is the inversion and adduction of the hindfoot. […] Equinus: The entire foot shows an increased plantar flexion at the ankle joint. […] The soft structures on the medial and posterior aspects of the foot are shortened and thickened keeping the position of the foot in adduction and varus with equinus respectively. […] The joints of the foot are distorted due to malposition of its bones.

• #35 clubfoot | The Foot and Ankle Online Journal

  http://faoj.org/tag/clubfoot/

  The talus is distorted in size, shape and orientation in case of clubfoot. […] The most apparent change in the talus is found in its anterior part. […] The navicular bone is dislocated medially lying opposite the tibial malleolus. […] The calcaneus in clubfoot is generally of normal shape but slightly smaller than that of normal foot. […] Management of neglected and severe resistant clubfoot represents a great challenge to orthopedic surgeons. […] Therefore, talectomy has been suggested to be a salvage surgical method for correction of such cases of clubfoot. […] Talectomy has been suggested as a salvage procedure to manage severe resistant cases of clubfoot. […] The operation gives satisfactory results through removing the talus “the most distorted bone”. […] Clubfoot is a challenging orthopedic problem especially in severe resistant cases. […] Future studies are also recommended particularly to reveal genetic involvement in its etiology.

• #36 clubfoot | The Foot and Ankle Online Journal

  http://faoj.org/tag/clubfoot/

  The talus is distorted in size, shape and orientation in case of clubfoot. […] The most apparent change in the talus is found in its anterior part. […] The navicular bone is dislocated medially lying opposite the tibial malleolus. […] The calcaneus in clubfoot is generally of normal shape but slightly smaller than that of normal foot. […] Management of neglected and severe resistant clubfoot represents a great challenge to orthopedic surgeons. […] Therefore, talectomy has been suggested to be a salvage surgical method for correction of such cases of clubfoot. […] Talectomy has been suggested as a salvage procedure to manage severe resistant cases of clubfoot. […] The operation gives satisfactory results through removing the talus “the most distorted bone”. […] Clubfoot is a challenging orthopedic problem especially in severe resistant cases. […] Future studies are also recommended particularly to reveal genetic involvement in its etiology.

• #37 SciELO Brazil – Pé torto congênito Pé torto congênito

  https://www.scielo.br/j/aob/a/WVjrRdz7zfrxPWwkpjFK8mR/?lang=en

  Three-dimensional bone connectivity is altered in a complex manner and, according to Ponseti, the most severe deformities are located in the hindfoot, where the talus and the calcaneus are in accentuated equinus, the calcaneus is positioned medially and angulated in varus, and the navicular exhibits accentuated medial deviation. […] The talus presents morphological malformation, and the neck is angulated medially and plantarly, in comparison to a normal foot. […] Moreover, in CC, the calf muscles are smaller, the foot size, as a whole, and that of the bones, individually, is also smaller. […] Vascular malformations were described in CC whose origin can be congenital, or otherwise adaptive to severe and prolonged deformity.

• #38 clubfoot | The Foot and Ankle Online Journal

  http://faoj.org/tag/clubfoot/

  The talus is distorted in size, shape and orientation in case of clubfoot. […] The most apparent change in the talus is found in its anterior part. […] The navicular bone is dislocated medially lying opposite the tibial malleolus. […] The calcaneus in clubfoot is generally of normal shape but slightly smaller than that of normal foot. […] Management of neglected and severe resistant clubfoot represents a great challenge to orthopedic surgeons. […] Therefore, talectomy has been suggested to be a salvage surgical method for correction of such cases of clubfoot. […] Talectomy has been suggested as a salvage procedure to manage severe resistant cases of clubfoot. […] The operation gives satisfactory results through removing the talus “the most distorted bone”. […] Clubfoot is a challenging orthopedic problem especially in severe resistant cases. […] Future studies are also recommended particularly to reveal genetic involvement in its etiology.

• #39 clubfoot | The Foot and Ankle Online Journal

  http://faoj.org/tag/clubfoot/

  The talus is distorted in size, shape and orientation in case of clubfoot. […] The most apparent change in the talus is found in its anterior part. […] The navicular bone is dislocated medially lying opposite the tibial malleolus. […] The calcaneus in clubfoot is generally of normal shape but slightly smaller than that of normal foot. […] Management of neglected and severe resistant clubfoot represents a great challenge to orthopedic surgeons. […] Therefore, talectomy has been suggested to be a salvage surgical method for correction of such cases of clubfoot. […] Talectomy has been suggested as a salvage procedure to manage severe resistant cases of clubfoot. […] The operation gives satisfactory results through removing the talus “the most distorted bone”. […] Clubfoot is a challenging orthopedic problem especially in severe resistant cases. […] Future studies are also recommended particularly to reveal genetic involvement in its etiology.

• #40 SciELO Brazil – Pé torto congênito Pé torto congênito

  https://www.scielo.br/j/aob/a/WVjrRdz7zfrxPWwkpjFK8mR/?lang=en

  Three-dimensional bone connectivity is altered in a complex manner and, according to Ponseti, the most severe deformities are located in the hindfoot, where the talus and the calcaneus are in accentuated equinus, the calcaneus is positioned medially and angulated in varus, and the navicular exhibits accentuated medial deviation. […] The talus presents morphological malformation, and the neck is angulated medially and plantarly, in comparison to a normal foot. […] Moreover, in CC, the calf muscles are smaller, the foot size, as a whole, and that of the bones, individually, is also smaller. […] Vascular malformations were described in CC whose origin can be congenital, or otherwise adaptive to severe and prolonged deformity.

• #41 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://atm.amegroups.org/article/view/66832/html

  This theory was later shared by other authors who reported atrophy and shortening of the leg muscles in fetuses affected by unilateral ICCF, mostly involving the posteromedial compartment of the leg. […] A preliminary histochemical study has shown a decrease of some muscle growth factors and the presence of myostatin that inhibits muscle growth in the soleus of children with ICCF, thus supporting our theory of impaired muscle growth.

• #42 The congenital clubfoot – immunohistological analysis of the extracell | ORR

  https://www.dovepress.com/the-congenital-clubfoot-immunohistological-analysis-of-the-extracellul-peer-reviewed-fulltext-article-ORR

  In order to better understand the pathogenesis of patients with primary clubfoot, we examined whether there are quantitative changes in the extracellular matrix (ECM; based on common interstitial collagens like CI and CIII, microfilamentous collagens like CVI, noncollagenous proteins like undulin, and enzymes like matrixmetalloproteinase [MMP]-2 and tissue inhibitor of matrixmetalloproteinase [TIMP]-2 that are known to play a role in fibrogenesis and fibrolysis) of muscles involved in the foot deformity of patients with primary clubfoot corresponding to fibrosis. […] The results obtained clearly indicate changes in the ECM of M. gastrocnemius compared with M. quadriceps femoris as a result of fibrosis in patients with primary clubfoot. […] Changes in the ECM of the M. gastrocnemius are of fibroproliferative origin. In contrast to other studies, we found increasing fibrosis not only in contracted tissues but also in the muscle itself. There are no changes in the ECM of the M. tibialis anterior, so its participation seems to be secondary. Increasing fibrosis in M. gastrocnemius could be an indicator for a higher risk of relapse.

• #43 The congenital clubfoot – immunohistological analysis of the extracell | ORR

  https://www.dovepress.com/the-congenital-clubfoot-immunohistological-analysis-of-the-extracellul-peer-reviewed-fulltext-article-ORR

  In order to better understand the pathogenesis of patients with primary clubfoot, we examined whether there are quantitative changes in the extracellular matrix (ECM; based on common interstitial collagens like CI and CIII, microfilamentous collagens like CVI, noncollagenous proteins like undulin, and enzymes like matrixmetalloproteinase [MMP]-2 and tissue inhibitor of matrixmetalloproteinase [TIMP]-2 that are known to play a role in fibrogenesis and fibrolysis) of muscles involved in the foot deformity of patients with primary clubfoot corresponding to fibrosis. […] The results obtained clearly indicate changes in the ECM of M. gastrocnemius compared with M. quadriceps femoris as a result of fibrosis in patients with primary clubfoot. […] Changes in the ECM of the M. gastrocnemius are of fibroproliferative origin. In contrast to other studies, we found increasing fibrosis not only in contracted tissues but also in the muscle itself. There are no changes in the ECM of the M. tibialis anterior, so its participation seems to be secondary. Increasing fibrosis in M. gastrocnemius could be an indicator for a higher risk of relapse.

• #44 Can clubfoot be corrected? A nonsurgical treatment method | Endeavor Health

  https://www.endeavorhealth.org/articles/clubfoot-nonsurgical-treatment-method

  Clubfoot is the most common congenital foot malformation, occurring in about one in 1,000 births. […] The underlying mechanism involves joint contractures of the bones, connective tissues and muscles of the foot and lower leg, which causes the bones in the foot to become misaligned and the Achilles tendon to be too short. […] Before the Ponseti method was widely accepted, many children with clubfeet were treated with major surgery. In the modern era, this is rare because casting has such a high success rate, said Dr. Roberts. […] These cases are big wins — this common yet serious congenital difference is successfully treated now with correcting casting and bracing, avoiding major surgery in almost all cases.

• #45 Clubfoot: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/16889-clubfoot

  Clubfoot happens because of an issue with your childs tendons, the tissues that connect muscle to bone. The tendons in your babys leg and foot are shorter and tighter than they should be. That causes the foot to twist. About half of babies with clubfoot have an issue with both feet. […] Researchers dont know the exact cause of clubfoot. Its most likely a combination of genetics and environment: […] A problem with one or more genes (which are passed down from parents to children) could result in clubfoot. […] Drug use and smoking during pregnancy may raise the risk of having a baby with a birth defect like clubfoot. […] Clubfoot isnt painful for your baby. Many babies wont even notice it during the first few months of life. But clubfoot will get in the way of standing and walking. It wont go away on its own.

• #46 Current Concepts in the Etiology, Diagnosis, and Management of Relapsed Clubfoot

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24317/JPJ/fullText

  Relapse is a recurrence of deformities in a previously corrected clubfoot. The incidence of relapse after the Ponseti method is reported between 26% and 48%. The etiology of relapse can be variable. Some of the predisposing factors that are predictive of relapse are drop toe signs, a lower ratio of correction improvement, and muscle imbalance. […] Children with a drop-toe sign have a high likelihood of relapse. The drop-toe sign involves, a resting position of the toes in plantarflexion along with no active toe extension in response to plantar stimulation of the foot. This finding was associated with the absent function of the anterior and lateral compartment muscles. […] Various factors have been attributed to the recurrence of the clubfoot. Recurrence could have multifactorial etiology. Dietz has found that AP radiographs frequently showed incomplete correction of a medially displaced navicular and a diminished talocalcaneal angle in patients with dynamic supination of the forefoot.

• #47

  https://link.springer.com/article/10.1007/s11999-009-0721-1

  The peroneal muscles are of necessity stretched by the deformed position of the foot and appear weaker than the supinators. Following the initial treatment, strength of the peronei and of foot dorsiflexors improve to normal in some children and maintain the foot well corrected. In some cases, however, the peronei remain weak and with a slight recurrence of heel inversion deformity the anterior tibial ceases to be a dorsiflexor and becomes purely a supinator. […] Anterior tibial tendon transfer to the third cuneiform is a useful operation for the treatment of cases of severe, relapsing clubfoot.

• #48 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  Various theories of the pathogenesis of clubfeet have been advanced, including the following: […] With respect to neurogenic factors, histochemical abnormalities have been found in posteromedial and peroneal muscle groups of patients with clubfeet. This is postulated to be due to innervation changes in intrauterine life secondary to a neurologic event, such as a stroke leading to mild hemiparesis or paraparesis. This is further supported by a 35% incidence of varus and equinovarus deformity in spina bifida. […] Retracting fibrosis (or myofibrosis) may occur secondary to increased fibrous tissue in muscles and ligaments. In fetal and cadaveric studies, Ponseti also found the collagen in all of the ligamentous and tendinous structures (except the Achilles [calcaneal] tendon), and it was very loosely crimped and could be stretched.

• #49 Pathogenesis of Clubfoot Deformity

  http://www.fetalultrasound.com/online/text/30-173.HTM

  Some authors have examined the contracted medial side and have suggested that the contracture of myofibroblast-like cells may have been enhanced by histamine release from the mast cells, which are also found in increased concentrations. […] Anomalous tendinous insertions of the Achilles tendon, tibialis anterior, and/or the peroneal tendons have also been blamed as the primary cause.

• #50 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2014.6.3.245

  The medial soft tissues remain stretched out only if the FAO is used after three weeks of casting. […] When a clubfoot is placed in the FAO, the affected foot is kept in 60 to 70 degrees of external rotation and in 10 to 15 degrees of dorsal flexion, and the posterior and medial ankle soft tissues are under static stretching by the FAO. […] It has been universally agreed that the initial management of congenital clubfoot should be non-operative. […] The presence of collagen, vimentin, and myofibroblast-like cells in the thick, tight, and shortened medial and posterior tarsal ligaments seems to play an important role in the pathogenesis and relapse of the clubfoot deformity.

• #51 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://atm.amegroups.org/article/view/66832/html

  A theory of retracting fibrosis involving the soft tissues of the posteromedial aspect of the leg and foot has been supported by the histologic observation of increased fibrous tissue within the ligaments, fasciae muscles and tendon sheaths. […] Dietz postulated the theory of a regional growth disorder, supported by two clinical observations. First, the leg and foot are smaller than normal in ICCF—the reduction of foot and leg size being more marked in severe deformities—and second, relapse in a corrected clubfoot occurs during the rapid growth period of the foot. […] The theory of muscle imbalance caused by a non-neurologic etiologic factor that impaired muscle growth was first proposed by Bechtol and Mossman, who dissected the unilateral ICCF of a 12-week-old fetus in which the foot deformity was caused only by the subluxation of the tarsal joints without any deformity of the tarsal bones.

• #52 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8339820/

  Several studies have described the pathology of idiopathic congenital clubfoot (ICCF) in fetus. Numerous pathogenetic theories have been postulated on ICCF, but many of them lack any objective evidence. Pathologic studies in fetus together with MRI studies in patients with ICCF seem to favor the theory of a muscular imbalance of the foot activators during fetal growth as the main pathogenetic factor of ICCF. […] The authors postulate that a defect of both the radial and the longitudinal growth unevenly affecting the leg muscles with a consequent imbalance of the foot activators might be the main pathogenetic factor of ICCF. Further studies are needed to confirm this theory. […] Many pathogenetic theories have been postulated in ICCF, but some of them have been based on assumptions lacking any objective evidence.

• #53 Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

  https://atm.amegroups.org/article/view/66832/html

  Several studies have described the pathology of idiopathic congenital clubfoot (ICCF) in fetus. Numerous pathogenetic theories have been postulated on ICCF, but many of them lack any objective evidence. Pathologic studies in fetus together with MRI studies in patients with ICCF seem to favor the theory of a muscular imbalance of the foot activators during fetal growth as the main pathogenetic factor of ICCF. […] The authors postulate that a defect of both the radial and the longitudinal growth unevenly affecting the leg muscles with a consequent imbalance of the foot activators might be the main pathogenetic factor of ICCF. Further studies are needed to confirm this theory. […] Many pathogenetic theories have been postulated in ICCF, but some of them have been based on assumptions lacking any objective evidence.

• #54 Clubfoot – Wikipedia

  https://en.wikipedia.org/wiki/Clubfoot

  The theory of fetal growth arrest was proposed by Von Volkmann in 1863, and has been verified by other authors since. According to this theory, intrinsic errors or environmental insults during gestation prevents the correction of an equinovarus to pronated foot. Other researchers hypothesize that clubfoot may derive from external insults during gestation. […] Mutations in genes involved in muscle development are risk factors for clubfoot, specifically those encoding the muscle contractile complex. Genetic mapping and the development of models of the disease have improved understanding of developmental processes. Its inheritance pattern is explained as a heterogenous disorder using a polygenic threshold model. The PITX1-TBX4 transcriptional pathway has become key to the study of clubfoot.

• #55 Orthopedics and Rheumatology open access journal (OROAJ)

  https://juniperpublishers.com/oroaj/OROAJ.MS.ID.555728.php

  Irani and Sherman had dissected 11 equinovarus feet and 14 normal feet and dissection revealed no primary abnormalities of the nerves, vessels, tendon, and muscle insertions. Constantly the abnormalities were found in the anterior part of the talus. The talus was undersized and its anterior portion was medially rotated. They suggested that the deformity probably resulted from a primary germ plasma defect. […] In 1863, Heuter and Von Volkman proposed that early in embryonic life, the arrest of fetal development was a cause of congenital clubfoot. […] The harmful influence of teratogenic agents on fetal environment and development are well illustrated by the effect of rubella and thalidomide. Many authors believe that club foot and temporary growth arrest happen due to various environmental factors.

• #56 Orthopedics and Rheumatology open access journal (OROAJ)

  https://juniperpublishers.com/oroaj/OROAJ.MS.ID.555728.php

  Irani and Sherman had dissected 11 equinovarus feet and 14 normal feet and dissection revealed no primary abnormalities of the nerves, vessels, tendon, and muscle insertions. Constantly the abnormalities were found in the anterior part of the talus. The talus was undersized and its anterior portion was medially rotated. They suggested that the deformity probably resulted from a primary germ plasma defect. […] In 1863, Heuter and Von Volkman proposed that early in embryonic life, the arrest of fetal development was a cause of congenital clubfoot. […] The harmful influence of teratogenic agents on fetal environment and development are well illustrated by the effect of rubella and thalidomide. Many authors believe that club foot and temporary growth arrest happen due to various environmental factors.

• #57 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  Various theories of the pathogenesis of clubfeet have been advanced, including the following: […] With respect to neurogenic factors, histochemical abnormalities have been found in posteromedial and peroneal muscle groups of patients with clubfeet. This is postulated to be due to innervation changes in intrauterine life secondary to a neurologic event, such as a stroke leading to mild hemiparesis or paraparesis. This is further supported by a 35% incidence of varus and equinovarus deformity in spina bifida. […] Retracting fibrosis (or myofibrosis) may occur secondary to increased fibrous tissue in muscles and ligaments. In fetal and cadaveric studies, Ponseti also found the collagen in all of the ligamentous and tendinous structures (except the Achilles [calcaneal] tendon), and it was very loosely crimped and could be stretched.

• #58 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  Various theories of the pathogenesis of clubfeet have been advanced, including the following: […] With respect to neurogenic factors, histochemical abnormalities have been found in posteromedial and peroneal muscle groups of patients with clubfeet. This is postulated to be due to innervation changes in intrauterine life secondary to a neurologic event, such as a stroke leading to mild hemiparesis or paraparesis. This is further supported by a 35% incidence of varus and equinovarus deformity in spina bifida. […] Retracting fibrosis (or myofibrosis) may occur secondary to increased fibrous tissue in muscles and ligaments. In fetal and cadaveric studies, Ponseti also found the collagen in all of the ligamentous and tendinous structures (except the Achilles [calcaneal] tendon), and it was very loosely crimped and could be stretched.

• #59 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  Various theories of the pathogenesis of clubfeet have been advanced, including the following: […] With respect to neurogenic factors, histochemical abnormalities have been found in posteromedial and peroneal muscle groups of patients with clubfeet. This is postulated to be due to innervation changes in intrauterine life secondary to a neurologic event, such as a stroke leading to mild hemiparesis or paraparesis. This is further supported by a 35% incidence of varus and equinovarus deformity in spina bifida. […] Retracting fibrosis (or myofibrosis) may occur secondary to increased fibrous tissue in muscles and ligaments. In fetal and cadaveric studies, Ponseti also found the collagen in all of the ligamentous and tendinous structures (except the Achilles [calcaneal] tendon), and it was very loosely crimped and could be stretched.

• #60 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  Inclan proposed that anomalous tendon insertions result in clubfeet. […] However, other studies have not supported this proposal. It is more likely that the distorted clubfoot anatomy can make it appear that tendon insertions are anomalous. […] Robertson noted seasonal variations to be a factor in his epidemiologic studies in developing countries. […] This coincided with a similar variation in the incidence of poliomyelitis in the children in the community. Clubfoot was therefore proposed to be a sequela of an antenatal poliolike condition. This theory was further supported by motor neuron changes in the anterior horn in the spinal cord of these babies.

• #61 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  Inclan proposed that anomalous tendon insertions result in clubfeet. […] However, other studies have not supported this proposal. It is more likely that the distorted clubfoot anatomy can make it appear that tendon insertions are anomalous. […] Robertson noted seasonal variations to be a factor in his epidemiologic studies in developing countries. […] This coincided with a similar variation in the incidence of poliomyelitis in the children in the community. Clubfoot was therefore proposed to be a sequela of an antenatal poliolike condition. This theory was further supported by motor neuron changes in the anterior horn in the spinal cord of these babies.

• #62 Pathogenesis of Clubfoot Deformity

  http://www.fetalultrasound.com/online/text/30-173.HTM

  Some authors have examined the contracted medial side and have suggested that the contracture of myofibroblast-like cells may have been enhanced by histamine release from the mast cells, which are also found in increased concentrations. […] Anomalous tendinous insertions of the Achilles tendon, tibialis anterior, and/or the peroneal tendons have also been blamed as the primary cause.

• #63 Effectiveness of the Ponseti Method in the Treatment of Clubfoot: A Systematic Review

  https://www.mdpi.com/1660-4601/20/4/3714

  Clubfoot is a common congenital deformity of the lower limbs. It is difficult to treat due to the pathological anatomy of the foot; therefore, it is important to understand the mechanism of correction and ensure patient follow-up. This pathology affects musculoskeletal structures of the feet, including the cavus, varus, adductus and equinus. The goal of treatment is to correct all components of the deformity through gradual ligamentous and muscular lengthening, achieving a flexible plantigrade foot without pain. […] The Ponseti method is the gold standard, being an effective and safe treatment for clubfoot. The method is based on gentle and repetitive manipulations that aim to stretch the soft tissues progressively, followed by cast immobilization weekly. […] The success of this technique depends on the manipulations and the regularity of cast changing, which should start as soon as possible.

• #64 Effectiveness of the Ponseti Method in the Treatment of Clubfoot: A Systematic Review

  https://www.mdpi.com/1660-4601/20/4/3714

  When the foot has achieved correction of the cavus, varus and adductus deformities, but has a dorsiflexion of less than 10°, Achilles tendon tenotomy is indicated to correct the equine. […] It has been shown in several studies that Pirani classification is very helpful throughout the treatment of clubfoot. It is based on three midfoot variables and three hindfoot variables. Each variable has a value from zero to one. Normally, a value is taken at the beginning and another value at the end of the study to check the progress of the foot. […] The study by Islam et al. makes a small improvement to the traditional Ponseti method. All the steps are the same except for the changing of casts, which is to be carried out twice a week. This reduces the time patients are immobilized in the cast. The accelerated Ponseti technique has been shown to have similar safety and is effective enough as a traditional treatment. This should be further investigated so that future generations have improved clubfoot correction.

• #65 Bracing in Clubfoot: What is Different in 2021?

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24316/JPJ/fullText

  Clubfoot correction by the Ponseti technique can be explained by creep and stress relaxation phenomenon. During serial manipulation and casting, tendons, ligaments, and soft tissues elongate under a constant load which is described as creep. After the final cast in maximum abduction and dorsiflexion, FAB creates stress relaxation of ligaments which is a decrease in load under continuous elongation. Foot abduction brace helps in continued stretching of posteromedial tissue and their development and thus helps in the prevention of recurrence. […] Ponseti stated that recurrence in clubfoot is not the result of under correction but it occurred because of the abnormality of the soft tissue of the lower leg, ankle, and foot which had caused the primary congenital deformity. […] In Ponsetis study, adherent patients had a recurrence rate of 7%, whereas non-adherent patients had a recurrence rate of 78%.

• #66 Bracing in Clubfoot: What is Different in 2021?

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24316/JPJ/fullText

  Clubfoot correction by the Ponseti technique can be explained by creep and stress relaxation phenomenon. During serial manipulation and casting, tendons, ligaments, and soft tissues elongate under a constant load which is described as creep. After the final cast in maximum abduction and dorsiflexion, FAB creates stress relaxation of ligaments which is a decrease in load under continuous elongation. Foot abduction brace helps in continued stretching of posteromedial tissue and their development and thus helps in the prevention of recurrence. […] Ponseti stated that recurrence in clubfoot is not the result of under correction but it occurred because of the abnormality of the soft tissue of the lower leg, ankle, and foot which had caused the primary congenital deformity. […] In Ponsetis study, adherent patients had a recurrence rate of 7%, whereas non-adherent patients had a recurrence rate of 78%.

• #67 Bracing in Clubfoot: What is Different in 2021?

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24316/JPJ/fullText

  Clubfoot correction by the Ponseti technique can be explained by creep and stress relaxation phenomenon. During serial manipulation and casting, tendons, ligaments, and soft tissues elongate under a constant load which is described as creep. After the final cast in maximum abduction and dorsiflexion, FAB creates stress relaxation of ligaments which is a decrease in load under continuous elongation. Foot abduction brace helps in continued stretching of posteromedial tissue and their development and thus helps in the prevention of recurrence. […] Ponseti stated that recurrence in clubfoot is not the result of under correction but it occurred because of the abnormality of the soft tissue of the lower leg, ankle, and foot which had caused the primary congenital deformity. […] In Ponsetis study, adherent patients had a recurrence rate of 7%, whereas non-adherent patients had a recurrence rate of 78%.

• #68 Bracing in Clubfoot: What is Different in 2021?

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24316/JPJ/fullText

  Clubfoot correction by the Ponseti technique can be explained by creep and stress relaxation phenomenon. During serial manipulation and casting, tendons, ligaments, and soft tissues elongate under a constant load which is described as creep. After the final cast in maximum abduction and dorsiflexion, FAB creates stress relaxation of ligaments which is a decrease in load under continuous elongation. Foot abduction brace helps in continued stretching of posteromedial tissue and their development and thus helps in the prevention of recurrence. […] Ponseti stated that recurrence in clubfoot is not the result of under correction but it occurred because of the abnormality of the soft tissue of the lower leg, ankle, and foot which had caused the primary congenital deformity. […] In Ponsetis study, adherent patients had a recurrence rate of 7%, whereas non-adherent patients had a recurrence rate of 78%.

• #69 Bracing in Clubfoot: What is Different in 2021?

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24316/JPJ/fullText

  Although the brace type, definition of recurrence, adherence, and bracing protocols is different in various studies, there is almost a consensus that FAB is mandatory for prevention of recurrence. […] Despite the availability of many braces, no brace design ensures 100% adherence or avoids potential complications like sleep disturbance, skin problems, etc. […] An ideal FAB should thus have the following characteristics: universal brace for different sizes of feet, low cost, child safety, user-friendly, skin-friendly, detachable shoes, adjustable bar length, compliance monitoring sensors, easy accessibility to all children all over the world/applicability in low-cost mass programs. […] Whatever be the advances, it also becomes essential that future researches have robust study designs and methodology. There should be uniformity in the definition of deformity correction, recurrence, non-adherence, and bracing protocols to compare the results with various types of FAB.

• #70 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2014.6.3.245

  During the period of brace wear, great concern has been expressed about recognition and prevention of the relapse of clubfoot deformity because in nearly all of the cases recurrence of clubfoot deformity occurs during this phase. […] The brace should be worn full time (day and night) for the first 3 months after the final cast is removed. After that, the child should wear the brace for 12 hours at night and 2 to 4 hours during the day, for a total of 14 to 16 hours during each 24-hour period. This protocol is continued until the child is 3 to 4 years of age. […] As described by Ponseti, the proper use of this method can be clearly divided into two phases. The first phase is the correction phase and the second phase is the maintenance phase. […] If a patient is not compliant with the brace treatment, he/she is more likely to have a relapse than the compliant patient.

• #71 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2014.6.3.245

  During the period of brace wear, great concern has been expressed about recognition and prevention of the relapse of clubfoot deformity because in nearly all of the cases recurrence of clubfoot deformity occurs during this phase. […] The brace should be worn full time (day and night) for the first 3 months after the final cast is removed. After that, the child should wear the brace for 12 hours at night and 2 to 4 hours during the day, for a total of 14 to 16 hours during each 24-hour period. This protocol is continued until the child is 3 to 4 years of age. […] As described by Ponseti, the proper use of this method can be clearly divided into two phases. The first phase is the correction phase and the second phase is the maintenance phase. […] If a patient is not compliant with the brace treatment, he/she is more likely to have a relapse than the compliant patient.

• #72 Current Concepts in the Etiology, Diagnosis, and Management of Relapsed Clubfoot

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24317/JPJ/fullText

  Relapse is a recurrence of deformities in a previously corrected clubfoot. The incidence of relapse after the Ponseti method is reported between 26% and 48%. The etiology of relapse can be variable. Some of the predisposing factors that are predictive of relapse are drop toe signs, a lower ratio of correction improvement, and muscle imbalance. […] Children with a drop-toe sign have a high likelihood of relapse. The drop-toe sign involves, a resting position of the toes in plantarflexion along with no active toe extension in response to plantar stimulation of the foot. This finding was associated with the absent function of the anterior and lateral compartment muscles. […] Various factors have been attributed to the recurrence of the clubfoot. Recurrence could have multifactorial etiology. Dietz has found that AP radiographs frequently showed incomplete correction of a medially displaced navicular and a diminished talocalcaneal angle in patients with dynamic supination of the forefoot.

• #73 Current Concepts in the Etiology, Diagnosis, and Management of Relapsed Clubfoot

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24317/JPJ/fullText

  Some studies have proposed that a muscle imbalance may be a causative factor in the development of a relapsed deformity. Gelfer et al. have found poor evertor muscle activity to be associated with recurrent deformity. […] The ratio of correction improvement RCI (defined as initial Pirani score divided by the number of casts necessary to achieve the correction) value is an indicator of risk of recurrence. Patients with a lower RCI value of <1 had an odds ratio of relapse 27 times higher than those with RCI > 1. […] Young age at tibialis anterior tendon transfer (TATT) is a known risk factor for the development of recurrence. The likelihood of the second relapse is almost 50% when TATT is done at age 2.5 years, the likelihood is 13% if the procedure is done after 2.5 years of age. […] The treatment of recurrent clubfoot that is not responding to Ponseti serial casting or the foot that has undergone multiple procedures poses multiple challenges such as wound breakdown, wound healing, vascular problems, and incomplete correction. The common indications to use external fixation are feet with extensive scarring from previous surgeries, severe rigid deformities that are recalcitrant to treatment. […] Severe, recalcitrant deformities can be treated by using an external fixator. There are two broad treatment categories (A) external fixator used for soft tissue distraction (joint sparing) and (B) external fixator combined with an osteotomy (joint invasive).

• #74 Current Concepts in the Etiology, Diagnosis, and Management of Relapsed Clubfoot

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24317/JPJ/fullText

  Some studies have proposed that a muscle imbalance may be a causative factor in the development of a relapsed deformity. Gelfer et al. have found poor evertor muscle activity to be associated with recurrent deformity. […] The ratio of correction improvement RCI (defined as initial Pirani score divided by the number of casts necessary to achieve the correction) value is an indicator of risk of recurrence. Patients with a lower RCI value of <1 had an odds ratio of relapse 27 times higher than those with RCI > 1. […] Young age at tibialis anterior tendon transfer (TATT) is a known risk factor for the development of recurrence. The likelihood of the second relapse is almost 50% when TATT is done at age 2.5 years, the likelihood is 13% if the procedure is done after 2.5 years of age. […] The treatment of recurrent clubfoot that is not responding to Ponseti serial casting or the foot that has undergone multiple procedures poses multiple challenges such as wound breakdown, wound healing, vascular problems, and incomplete correction. The common indications to use external fixation are feet with extensive scarring from previous surgeries, severe rigid deformities that are recalcitrant to treatment. […] Severe, recalcitrant deformities can be treated by using an external fixator. There are two broad treatment categories (A) external fixator used for soft tissue distraction (joint sparing) and (B) external fixator combined with an osteotomy (joint invasive).

• #75 Current Concepts in the Etiology, Diagnosis, and Management of Relapsed Clubfoot

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24317/JPJ/fullText

  Some studies have proposed that a muscle imbalance may be a causative factor in the development of a relapsed deformity. Gelfer et al. have found poor evertor muscle activity to be associated with recurrent deformity. […] The ratio of correction improvement RCI (defined as initial Pirani score divided by the number of casts necessary to achieve the correction) value is an indicator of risk of recurrence. Patients with a lower RCI value of <1 had an odds ratio of relapse 27 times higher than those with RCI > 1. […] Young age at tibialis anterior tendon transfer (TATT) is a known risk factor for the development of recurrence. The likelihood of the second relapse is almost 50% when TATT is done at age 2.5 years, the likelihood is 13% if the procedure is done after 2.5 years of age. […] The treatment of recurrent clubfoot that is not responding to Ponseti serial casting or the foot that has undergone multiple procedures poses multiple challenges such as wound breakdown, wound healing, vascular problems, and incomplete correction. The common indications to use external fixation are feet with extensive scarring from previous surgeries, severe rigid deformities that are recalcitrant to treatment. […] Severe, recalcitrant deformities can be treated by using an external fixator. There are two broad treatment categories (A) external fixator used for soft tissue distraction (joint sparing) and (B) external fixator combined with an osteotomy (joint invasive).

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