Clubfoot Birth Deformity

My niece, Amia Charay Taylor was born on September 28, 2011 with intrinsic talipes equinovarus, commonly known as clubfoot. Clubfoot occurs in 1-2 newborns per 1,000 and is a congenital deformity. Clubfoot is hypothesized to develop intrauterinely. The deformity is characterized by four main characteristics: equinius, or limitation of ankle and subtalar joint extension, internal rotation of the leg, inversion and adduction of the forefoot, and inversion of the heel and hindfoot (Gore & Spencer, 2004). There are two classifications of clubfoot: extrinsic and intrinsic. Extrinsic is the supple type of clubfoot that is essentially a severe positional deformity or a soft tissue deformity. Intrinsic clubfoot, on the other hand, is a rigid deformity that usually requires surgical repair.

Clubfoot is diagnosed by physical examinations after birth. The Achilles tendon is significantly tight, allowing little dorsiflexion. The inversion of the legs and the tightened Achilles tendon is what distinguishes clubfoot from pigeon toe, another similar foot deformity common in newborns. A "V-finger test" can also be used to test for clubfoot. Basically, if the foot does not line up parallel with your pointer and middle fingers, there is strong indication of clubfoot (see image: Gore & Spencer, 2004). If X-rays are required, the two bones of the ankle, the talus and the calcaneus, are nearly parallel each other.

Amia has undergone weekly cast changings in order to slowly stretch her Achilles tendon and straighten her legs and feet. Within two months, intrinsic clubfoot sometimes requires surgical repair in which the Achilles tendons are cut and left to heal on their own. Continued castings are required for the next three months when leg braces replace the casts. The leg braces are permanent for the following three months and for the next three years are only required during nap times and nightly sleeping.

Gore, Alvin & Spencer, Jeanne. The newborn foot. Am Fam Physician. 15 Feb 2004.