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Clubfoot is a congenital or neuromuscular deformity in which the hindfoot is fixed in equinus (plantar flexion) and varus (toward the midline) and the forefoot is fixed in varus, equinus, and often cavus (high midfoot arch with overextension).
- Risk of deformity increases by 20–30 times when there is an affected 1st-degree relative.
- Male > female (2:1)
Incidence is 1–1.4/1,000 live births but can vary among different ethnic groups.
- Many anatomic abnormalities have been postulated as causing clubfoot:
- Anomalous or deficient muscles, myoblasts, mast cells, abnormal primary bone formation, joint and muscle contractures, vascular anomalies (absent dorsalis pedis artery), and nerve anomalies
- Abnormalities of the fibrous connective tissue
- Interruption of embryonic foot development has also been suggested.
- Most cases are idiopathic (multifactorial inheritance pattern with significant environmental influence).
- Infrequently, neuromuscular imbalance may underlie the deformity (cerebral palsy, myelomeningocele, lipomas of the cord, caudal or sacral agenesis, polio, arthrogryposis, fetal alcohol syndrome).
- Rapid recurrence should prompt a thorough examination for possible underlying etiologies.