Clubfoot Clinical Presentation

Updated: Apr 17, 2017
  • Author: Minoo Patel, MBBS, PhD, MS, FRACS; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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History and Physical Examination

Seek a detailed family history of clubfoot or neuromuscular disorders, and perform a general examination to identify any other abnormalities. Examine the feet with the child prone, with the plantar aspect of the feet visualized, and supine to evaluate internal rotation and varus. If the child can stand, determine whether the foot is plantigrade, whether the heel is bearing weight, and whether it is in varus, valgus, or neutral.

Similar deformities are seen with myelomeningocele and arthrogryposis. Therefore, always examine for these associated conditions. The ankle is in equinus, and the foot is supinated (varus) and adducted (a normal infant foot usually can be dorsiflexed and everted, so that the foot touches the anterior tibia). Dorsiflexion beyond 90° is not possible.

The navicular is displaced medially, as is the cuboid. Contractures of the medial plantar soft tissues are present. Not only is the calcaneus in a position of equinus, but also the anterior aspect is rotated medially and the posterior aspect laterally.

The heel is small and empty. The heel feels soft to the touch (akin to the feel of the cheeks). As the treatment progresses, it fills in and develops a firmer feel (akin to the feel of the nose or of the chin).

The talar neck is easily palpable in the sinus tarsi as it is uncovered laterally. Normally, this is covered by the navicular, and the talar body is in the mortise. The medial malleolus is difficult to palpate and is often in contact with the navicular. The normal navicular-malleolar interval is diminished.

The hindfoot is supinated, but the foot is often in a position of pronation relative to the hindfoot. (See the image below.) The first ray often drops to create a position of cavus. The Ponseti method of closed management of clubfeet through manipulations and casting describes the elevation of the first metatarsal as a first step, even if it means seemingly exacerbating the supination of the foot.

Spontaneous correction of the hind foot varus by a Spontaneous correction of the hind foot varus by abducting the forefoot and allowing the calcaneum to freely rotate under the talus.

The tibia often has internal torsion. This assumes special importance in the casting management of clubfeet, where care should be taken to rotate the feet into abduction, avoiding spurious tibial rotation through the knee. (See the images below.) Even after correction, the foot often remains short and the calf thin.

Never forcibly evert or pronate the foot during cl Never forcibly evert or pronate the foot during clubfoot casting.
Traditional manipulation and casting methods fail, Traditional manipulation and casting methods fail, as they do not allow the free rotation of the calcaneum and the talus.