Profile of Paediatric Patients With Clubfoot Attending Tertiary Care Hospital: A Descriptive Study

INTRODUCTION Clubfoot is a major structural birth defect of the foot. It may occur as part of a greater syndrome or as an isolated malformation. A combination of genetic and environmental factors appears to be associated with the congenital clubfoot deformity. Its incidence varies with genetic background, gender and race. Suggestions of a genetic association include studies that have revealed that the concordance of clubfoot is about 33% for monozygotic twins versus only 3% for dizygotic twins.4 A higher risk among rst-degree relatives than among more distant relatives has been noted in several epidemiological studies.1,5-7 Furthermore, the risk among rstdegree relatives of female clubfoot cases is higher (4.3%) than that in male clubfoot cases (1.3%).8 These studies explain only the minority of clubfoot occurrences, leaving most as idiopathic or unknown cause. Clubfoot occurs in 1 in 1000 live births and is one of the most common birth defects involving the musculoskeletal system1. CTEV results in an equine deformity characterized by ankle plantar exion, subtalar inversion and adduction of the hindand forefoot. The foot itself is usually short and broad in appearance. The muscles of the lower leg are often small in diameter and do not fully develop. The incidence among different races ranges from 0.39 per 1000 among the Chinese population to 1.2 per 1000among Caucasian to 6.8 per 1000 among Polynesians2. Lochmiller 1998 reported a male to female ratio of 2.5:1 and 24.4% of the affected individuals have a family history of idiopathic talipesequinovarus3. The prevalence of this anomaly is reported to be between 0.39 and 6 cases in each 1000 live births; this wide difference is mainly due to ethnic factors4,5. It is more prevalent in males (M/ F=2.5/1). Clubfoot is about 30 times more common in the rst degree relatives of the patients with clubfoot5. The etiology of clubfoot is still unknown. Many theories such as vascular, viral, genetic, anatomic, environmental and positional factors have been proposed5. None of these theories has proved to be the main pathogenesis of clubfoot, but a multifactorial theory best justies this disease process. Clubfoot may be either primary (idiopathic) or secondary. Secondary types of this disease are associated with syndromes like arthrogryposis, streeter dysplasia, mobios syndrome or diasthrophic dysplasia. In these conditions, dysplasia is seen diffusely in nearly all neuromuscular tissues, while in the idiopathic type, the dysplastic tissue is limited to the foot or at most to the leg5. The diagnosis of clubfoot is clinical and is conrmed by radiographic assessment of the foot and ankle4.