Bilateral clubfoot - congenital talipes equinovarus
Updates to Case Attributes
Congenital clubfoot is best diagnosed by ultrasound between 18 to 24th weeks of gestation. In 50% of cases, the condition may be bilateral. False positive reports may be seen in 20-25% of cases, careful examination of feet on several occasions by experienced observers may reduce errors 3. Clubfoot occurs because of short tendons of the feet. Early intervention produces good results in most cases.
Diagnosis of clubfoot should preferably not be made before 12 weeks of gestation because the transient club foot-like position is present during the early normal development of feet 4. In the present case, the fetus had multiple congenital anomalies, including lemon sign, banana sign, open spina bifida, meningomyelocele, oligohydramnios, double vessel cord and musculoskeletal defects like persistent scissoring of legs. Repeated ultrasound examinations were performed to rule out positional false positive diagnoses of scissoring and club foot. False positive reports of clubfoot may be seen in 20-25% of cases, and careful examination of feet on several occasions by experienced observers may reduce errors 1.
Half the cases may be associated with other congenital anomalies like spina bifida, trisomy 13, trisomy 18 and several other conditions.
-<p>Congenital clubfoot is best diagnosed by ultrasound between 18 to 24<sup>th</sup> weeks of gestation. In 50% of cases, the condition may be bilateral. False positive reports may be seen in 20-25% of cases, careful examination of feet on several occasions by experienced observers may reduce errors <sup>3</sup>. Clubfoot occurs because of short tendons of the feet. Early intervention produces good results in most cases.</p><p>Diagnosis of clubfoot should preferably not be made before 12 weeks of gestation because the transient club foot-like position is present during the early normal development of feet <sup>4</sup>. In the present case, the fetus had multiple congenital anomalies including lemon sign, banana sign, open spina bifida, meningomyelocele, oligohydramnios, double vessel cord and musculoskeletal defects like persistent scissoring of legs.</p>- +<p>In the present case, the fetus had multiple congenital anomalies, including lemon sign, banana sign, open spina bifida, meningomyelocele, oligohydramnios, double vessel cord and musculoskeletal defects like persistent scissoring of legs. Repeated ultrasound examinations were performed to rule out positional false positive diagnoses of scissoring and club foot. False positive reports of clubfoot may be seen in 20-25% of cases, and careful examination of feet on several occasions by experienced observers may reduce errors <sup>1</sup>.</p><p>Half the cases may be associated with other congenital anomalies like <a href="/articles/spina-bifida" title="Spina bifida">spina bifida</a>, <a href="/articles/trisomy-13" title="trisomy 13">trisomy 13</a>, <a href="/articles/trisomy-18" title="trisomy 18">trisomy 18</a> and several other conditions.</p>
References changed:
- 1. Faldini C, Fenga D, Sanzarello I, Nanni M, Traina F, Rosa MAA. Prenatal Diagnosis of Clubfoot: A Review of Current Available Methodology. Folia Med (Plovdiv). 2017 Sep 1. 59 (3):247-253
- 4. Bogers H, Rifouna MS, Cohen-Overbeek TE, Koning AHJ, Willemsen SP, van der Spek PJ, et al. First trimester physiological development of the fetal foot position using three-dimensional ultrasound in virtual reality. J Obstet Gynaecol Res. 2019 Feb. 45 (2):280-288.
- 1. McKinney J, Rac MWF, Gandhi M. Congenital talipes equinovarus (clubfoot). Am J Obstet Gynecol. 2019 Dec. 221 (6):B10-B12.
- 2. Smythe T, Kuper H, Macleod D, Foster A, Lavy C. Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: a systematic review and meta-analysis. Trop Med Int Health. 2017 Mar. 22 (3):269-285.
- 3. Faldini C, Fenga D, Sanzarello I, Nanni M, Traina F, Rosa MAA. Prenatal Diagnosis of Clubfoot: A Review of Current Available Methodology. Folia Med (Plovdiv). 2017 Sep 1. 59 (3):247-253
Updates to Freetext Attributes
Epidemiology
Prevalence of 0.1% or 1 in 1000 live births for congenital clubfoot 1. Males are twice more affected than females. Higher prevalence rates are observed in lower socio-economic strata, with genetic factors and environmental conditions 2.
Updates to Freetext Attributes
Ultrasound is the investigation of choice. Half the cases may be associated with other congenital anomalies like spina bifida, trisomy 13, trisomy 18 and several other conditions. 50% of cases may have isolated congenital talipes equinovarus deformity. No fetal karyotyping is advisable in cases with isolated club foot 3.
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