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| | __NOTOC__ |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = {{PAGENAME}} | | | Name = {{PAGENAME}} | |
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| OMIM = 119800 | | | OMIM = 119800 | |
| MedlinePlus = | | | MedlinePlus = | |
| eMedicineSubj = radio |
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| eMedicineTopic = 177 |
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| eMedicine_mult = {{eMedicine2|orthoped|598}} |
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| MeshID = D003025 | | | MeshID = D003025 | |
| }} | | }} |
| {{SI}} | | {{Club foot}} |
| {{CMG}}
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| | '''For patient information, click [[Club foot (patient information)|here]]''' |
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| | {{CMG}} |
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| A '''clubfoot''', or ''talipes equinovarus''<ref>The term ''talipes'' is from [[Latin]] [[wiktionary:talus|talus]], ''ankle'' + [[wiktionary:pes|pes]], ''foot''. [[wiktionary:equino|Equino-]], ''of or resembling a horse'' and [[wiktionary:-varus|-varus]], ''turned inward''.</ref> (TEV), is a [[birth defect]]. The foot is twisted in (inverted) and down. Without treatment , persons afflicted often appear to walk on their [[ankles]], or on the sides of their feet. It is a common [[birth defect]], occurring in about one in every 1,000 live births. Approximately 50% of cases of clubfoot are bilateral. In most cases it is an isolated [[dysmelia]]. Incidence in males is higher than in females.
| | {{SK}} Talipes; clubfoot; equinovarus; talipes equinovarus; congenital talipes equinovarus |
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| ==Causes==
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| There are different causes for clubfoot:
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| Mainly caused by [[Edwards' syndrome]], a genetic defect with three copies of chromosome 18
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| [[Genetics|genetic]] causes with incidence rates increasing significantly when multiple direct family members have the condition
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| external influences such as [[intrauterine compression]] from [[oligohydramnios]] or from [[amniotic band syndrome]].
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| TEV may be associated with other birth defects such as [[spina bifida]] cystica.
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| Use of [[MDMA]] (Ecstasy) while pregnant has been linked with this congenital abnormality.<ref name=McElhatton>{{{{cite journal |author=McElhatton PR, Bateman DN, Evans C, Pughe KR, Thomas SH |title=Congenital anomalies after prenatal ecstasy exposure |journal=Lancet |volume=354 |issue=9188 |pages=1441–2 |year=1999 |pmid=10543673 |doi=}}</ref>
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| ==Treatments==
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| Clubfoot is treated with manipulation largely by a podiatrist, sometimes an orthopedic surgeons, specialist nurses, or [[orthotists]], will treat the condition by providing FAB braces to hold the feet in orthodox positions, serial casting, or small splints called knee ankle foot orthoses(KAFO). Other orthotic options include Denise-Brown bars with straight last boots, ankle foot orthoses (AFO) and/or custom foot orthoses (CFO). In North America, manipulation is followed by serial casting, most often by the Ponseti Method. Foot manipulations usually begin within two weeks of birth. Even with successful treatment, when only one side is affected, that foot may be smaller than the other, and often that calf, as well.
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| Extensive surgery of the soft tissue or bone is not usually necessary to treat clubfoot; however, there are two minimal surgeries that may be required: 1. Tenotomy (needed in 80% of cases) is a release (clipping) of the Achilles tendon - minor surgery- local anesthesia and 2. Anterior Tibial Tendon Transfer (needed in 20% of cases) - where the tendon is moved from the first ray (toe) to the third ray in order to release the inward traction on the foot. Of course, each case is different but the main idea is that extensive surgery is not needed to treat clubfoot. Extensive surgery may lead to scar tissue developing inside the child's foot. The scarring may result in functional, growth and aesthetic problems in the child's foot because the scarred tissue will interfere with the normal development of the foot. A child who has extensive surgery may require on average 2 additional surgeries to correct the issues presented above.
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| In stretching and casting therapy the doctor changes the cast multiple times over a few weeks, gradually stretching tendons until the foot is in the correct position of external rotation. The heel cord is released (percutaneous tenotomy) and another cast is put on, which is removed after three weeks. To avoid relapse a corrective brace is worn for a gradually reducing time until it is only at night up to four years of age.
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| ===Ponseti Method===
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| [[Image:P3240003.jpg|200px|thumb|left|Club foot.]]
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| The clubfoot treatment method that is becoming the standard in US and worldwide is known as the [[Ponseti Method]] <ref>[http://www.uihealthcare.com/topics/medicaldepartments/orthopaedics/clubfeet/index.html To Parents of Children Born with Clubfeet: Orthopaedics: UI Health Topics<!-- Bot generated title -->]</ref>. Foot manipulations differ subtly from the Kite casting method which prevailed during the late 20th century. Although described by Dr. Ignacio [[Ponseti]] in the [[1950s]], it did not reach a wider audience until it was re-popularized by Dr. John Herzenberg in [[2000]] and by parents of children with clubfeet using the Internet <ref>[http://health.groups.yahoo.com/group/nosurgery4clubfoot/ nosurgery4clubfoot : nosurgery4clubfoot<!-- Bot generated title -->]</ref>. The Ponseti method, if correctly done, is successful in >95% of cases <ref>[http://pediatrics.aappublications.org/cgi/content/full/113/2/376 Radical Reduction in the Rate of Extensive Corrective Surgery for Clubfoot Using the Ponseti Method - Morcuende et al. 113 (2): 376 - Pediatrics<!-- Bot generated title -->]</ref> in correcting clubfeet using non- or minimal-surgical techniques. Typical clubfoot cases usually require 5 casts over 4 weeks. Atypical clubfeet and complex clubfeet may require a larger number of casts. Approximately 80% of infants require an Achilles tenotomy (microscopic incision in the tendon requiring only local anesthetic and no stitches) performed in a clinic toward the end of the serial casting.
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| After correction has been achieved, maintenance of correction may require the full-time (23 hours per day) use of a splint—also known as a foot abduction brace (FAB)—on both feet, regardless or whether the TEV is on one side or both, for several weeks after treatment. Part-time use of a brace (generally at night, usually 12 hours per day) is frequently prescribed for up to 4 years. Approximately 20% of infants successfully treated with the Ponseti casting method may require a surgical tendon transfer after two years of age. While this requires a general anesthetic, it is a relatively minor surgery that corrects a persistent muscle imbalance while avoiding disturbance to the joints of the foot.
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| The developer of the Ponseti Method, [http://www.uihealthcare.com/topics/medicaldepartments/orthopaedics/clubfeet/contact.html Dr Ignacio Ponseti], at 93 years of age is still treating children with clubfeet (including complex/atypical clubfeet and failed treatment clubfeet) at the University of Iowa Hospitals and Clinics. He is assisted by Dr Jose Morcuende, president of the [http://www.ponseti.info Ponseti International Association].
| | == [[Club foot overview|Overview]] == |
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| The long-term outlook <ref>[http://www.uihealthcare.com/news/currents/vol1issue1/clubfoot.html]</ref> for children who experienced the Ponseti Method treatment is comparable to that of non-affected children.
| | == [[Club foot historical perspective|Historical Perspective]] == |
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| [http://www.clubfeet.net/video.php Watch a Video on the Ponseti Method] | | == [[Club foot classification|Classification]] == |
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| ==Famous people== | | == [[Club foot pathophysiology|Pathophysiology]] == |
| [[Image:José de Ribera 017.jpg|thumb|200px|left|The club-foot, by [[José de Ribera]].]] | |
| Many notable people have been born with club foot, including the Roman emperor [[Claudius]], the poet [[George Byron, 6th Baron Byron|Lord Byron]], statesman [[Talleyrand|Prince Talleyrand]], Civil War politician [[Thaddeus Stevens]], the comedian [[Damon Wayans]], actors [[Gary Burghoff]] and [[Dudley Moore]], footballer [[Steven Gerrard]], and film director [[David Lynch]].
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| [[Kristi Yamaguchi]] was reportedly born with a club foot, and went on to win figure skating gold in [[1992]]. Soccer star [[Mia Hamm]] was born with the condition. Baseball pitcher [[Larry Sherry]] was born with club feet, as was pitcher [[Jim Mecir]], and both enjoyed long and successful careers. [[Pittsburgh Pirates]] infielder [[Freddy Sanchez]] cites his ability to overcome the defect as a reason for his success <ref>[http://www.post-gazette.com/pg/06230/714467-63.stm Freddy or not, here comes last leg of batting race<!-- Bot generated title -->]</ref>. | | == [[Club foot causes|Causes]] == |
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| Dallas Cowboys quarterback [[Troy Aikman]] also overcame the condition en route to a [[Pro Football Hall of Fame]] career.
| | == [[Club foot differential diagnosis|Differentiating Club foot from other Diseases]] == |
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| [[Josef Goebbels]], the notorious Nazi propaganda minister, had a right club foot (possibly incurred after birth as a complication of osteomyelitis)<ref>Goebbels is commonly said to have had [[club foot]] (''talipes equinovarus''), a congenital condition. But William L. Shirer, who spent the 1930s in Berlin as a journalist and was acquainted with Goebbels, wrote in ''The Rise and Fall of the Third Reich'' (Simon and Schuster 1960) that the deformity arose from a childhood attack of [[osteomyelitis]] and a botched operation to correct it. Osteomyelitis, an infection within the bone marrow, can cause the destruction of one or more of the growing points in the long bones of the leg, a condition known as ''septic osteoblastic dysgenesis''. This will result in a shortened leg.</ref>, a fact hidden from the German public by censorship. Because of this malformation, Goebbels needed to wear a leg brace. That, plus his short stature, led to his rejection for military service in [[World War I]]. | | == [[Club foot epidemiology and demographics|Epidemiology and Demographics]] == |
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| == In literature == | | == [[Club foot risk factors|Risk Factors]] == |
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| The main character, Philip Carey, in [[W. Somerset Maugham]]'s novel ''[[Of Human Bondage]]'', has a club foot, a central theme in the work.
| | == [[Club foot screening|Screening]] == |
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| Hippolyte Tautain, the stable man at the Lion D'Or public house in [[Gustave Flaubert]]'s novel ''[[Madame Bovary]]'' is unsuccessfully treated for clubfoot by Charles Bovary, leading to the eventual amputation of his leg.
| | == [[Club foot natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| Charlie Wilcox, the main character in the novel ''Charlie Wilcox'' by Sharon McKay had a club foot.
| | == Diagnosis == |
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| In [[Yukio Mishima]]'s seminal novel [[The Temple of the Golden Pavilion]] the character Kashiwagi has club feet which parallels the stutter of the main character, Mizoguchi.
| | [[Club foot history and symptoms|History and Symptoms]] | [[Club foot physical examination|Physical Examination]] | [[Club foot foot x ray|Foot X Ray]] | [[Club foot foot CT|Foot CT]] | [[Club foot foot MRI|Foot MRI]] |
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| In the [[Mallorean]], Senji the sorcerer has a club foot.
| | == Treatment == |
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| In Caroline Lawrence's ''Roman Mysteries'' series, a character called Vulcan the blacksmith appears in the book "The Secrets of Vesuvius". He reveals that he gained the nickname because of his club foot.
| | [[Club foot surgery|Surgery]] | [[Club foot primary prevention|Primary Prevention]] | [[Club foot secondary prevention|Secondary Prevention]] | [[Club foot cost-effectiveness of therapy|Cost Effectiveness of Therapy]] | [[Club foot future or investigational therapies|Future or Investigational Therapies]] |
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| ==External links== | | ==Case Studies== |
| *[http://www.ponseti.info/parents Ponseti International site for Parents]
| | [[Club foot case study one|Case #1]] |
| *[http://www.ponseti.info Ponseti International site for health care providers]
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| *[http://www.steps-charity.org.uk/links/4-14-clubfoottalipes.php Steps Charity Worldwide]
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| *[http://www.uihealthcare.com/topics/medicaldepartments/orthopaedics/clubfeet/index.html Dr. Ponseti's website]
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| *[http://www.marchofdimes.com/professionals/681_1211.asp Clubfoot Fact Sheet (March of Dimes)]
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| *[http://www.clubfoot.co.za/about_clubfoot.htm South African website with information about clubfoot for parents]
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| *[http://www.clubfeet.net ClubFeet.net, Information and advice on ClubFeet]
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| *[http://www.clubfootclub.org Clubfootclub.org]
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| *[http://www.clubfoot.co.uk/index.htm Clubfoot.co.uk]
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| *[http://www.lifebridgehealth.org/sinaibody.cfm?id=2360 The Rubin Institute for Advanced Orthopedics at Sinai Hospital]
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| ==References==
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| <References/> | | <References/> |
