Prenatal diagnosis of talipes equinovarus (clubfoot)
- Urania Magriples, MD
Urania Magriples, MD
- Associate Professor of Obstetrics and Gynecology
- Yale University School of Medicine
- Section Editors
- Louise Wilkins-Haug, MD, PhD
Louise Wilkins-Haug, MD, PhD
- Section Editor — Prenatal Diagnosis and Genetics
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
Clubfoot, or talipes equinovarus, refers to a developmental deformity of the foot in which one or both feet are excessively plantar flexed, with the forefoot swung medially and the sole facing inward (picture 1). It is a common congenital malformation, typically discovered at the time of birth as an isolated anomaly in an otherwise normal neonate.
Clubfoot can be classified as congenital, syndromic, or positional. The congenital foot deformity affects the bones, muscles, tendons, and blood vessels of one or both feet. Syndromic cases are associated with additional anatomic malformations and/or chromosomal or genetic abnormalities. A positional clubfoot results from the baby's position in the uterus, and is often associated with a restrictive uterine environment (oligohydramnios, uterine anomalies). A positional clubfoot is flexible, rather than rigid, and can be positioned into a neutral position easily by hand.
PREVALENCE AND EPIDEMIOLOGY
The prevalence of clubfoot is 1 to 3 per 1000 live births in Caucasians . Male fetuses are predominately affected, with a 2-to-1 male to female ratio. The birth prevalence varies among different ethnic groups; the highest rates are seen in individuals of Polynesian ancestry (7 per 1000 live births) and the lowest in Asian populations (0.57 per 1000 live births) .
Clubfoot is bilateral in 30 to 60 percent of cases.
EMBRYOLOGY OF FOOT DEVELOPMENT
The foot sequentially assumes three different positions during embryonic and early fetal life: at the 15-mm stage (about 8 weeks of gestation), the foot is in a straight line with the leg; by the 30-mm stage (about 10 weeks of gestation), the foot rotates to a marked equinovarus-adductus position; and then by the 50-mm stage (about 11.5 weeks), it changes to a slightly equinovarus adductus position, which remains throughout fetal life [3,4]. These positional changes result from the growth of the distal ends of the fibula and the skeletal elements of the lateral foot during the "fibular phase" of rapid growth.
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