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Etiology and Associated Anomalies

  1. Idiopathic (most common)
  2. Secondary club foot
    1.  Neurological disorders & neural tube defects eg myelonieningocele, & spinal dysraphism
    2.  Paralytic disorder (due to muscular imbalance) as polio, spina bifida, myelodysplasia, & Freidreich’s ataxia
    3.  Arthrogryposis Multiplex congenita
    4.  Larsen syndrome
    5.  Freeman- sheldon syndrome
    6.  Diastrophic dwarfism
    7.  Sacral agenesis, tibial deficiency, constriction rings & amniotic bands 
  3. Pathological Anatomy
    1. The club foot characteristically involves foot ankle and leg. Deformities of foot may be in the hind foot (ankle & subtalar joints), mid foot (mid tarsal i.e. talonavicular & calcaneo cuboid joints).
    2. Talo calcaneo navicular joint complex is area involved in pathomechanics of all hind foot & mid foot deformities.
    3. Clubfoot is always associated with a permanent decrease in calf circumference related to fibrosis of calf musculature. 
  4. Ankle (Tibio talar) Joint
    Plantar flexion or Equinus
  5. Subtalar (Talocalcaneal) Joint
    Inversion, (axial internal rotation) and adduction causing hind foot (heel) varus.
  6. Mid tarsal (talonavicular & calcaneocuboid) Joint
    Adduction (medial subluxation) and inversion (supination) of mid and fore foot

Treatment algorithm:
  1. <1: Casting (Ponset method )
  2. >1:Soft tissue(PMSTR/CSTR)
  3. >3:Evan+Soft tissue
  4. >5:Dwyer+Soft tissue
  5. >8: wedge tarsectomy
  6. >12:Triple arthrodesis
Others: Illizarow, JESS

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