The Journal of Bone and Joint Surgery (American) 84:290 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Instructional Course Lecture |
Congenital Clubfoot
R. Jay Cummings, MD,
Richard S. Davidson, MD,
Peter F. Armstrong, MD, FRCS(C), FAAP and
Wallace B. Lehman, MD
An Instructional Course Lecture, American Academy of Orthopaedic
Surgeons
R. Jay Cummings, MD
Nemours Children’s Clinic, 807 Nira Street, Jacksonville,
FL 32207
Richard S. Davidson, MD
University of Pennsylvania School of Medicine, Wood Building,
Second Floor, 34th Street and Civic Center Boulevard, Philadelphia,
PA 19104-4399
Peter F. Armstrong, MD, FRCS(C), FAAP
Shriners Hospitals for Children, P.O. Box 31356, Tampa, FL 33631-3356
Wallace B. Lehman, MD
Hospital for Joint Diseases, 301 East 17th Street, Room 835, New
York, NY 10003-3899
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. They did not
receive payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other charitable
or nonprofit organization with which the authors are affiliated
or associated.
Printed with permission of the American Academy of Orthopaedic
Surgeons. This article, as well as other lectures presented at the
Academy’s Annual Meeting, will be available in March 2002
in Instructional Course Lectures, Volume 51. The complete volume
can be ordered online at www.aaos.org, or by calling 800-626-6726
(8 a.m.-5 p.m., Central time).
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Etiology
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Genetic Factors
The incidence of clubfoot varies widely with respect to race
and gender and increases with the number of affected relatives, suggesting
that the etiology is at least partly influenced by genetic factors1. The incidence among different races
ranges from 0.39 per 1000 among the Chinese population to 1.2 per
1000 among Caucasians to 6.8 per 1000 among Polynesians2,3p. Lochmiller et al. recently reported
a male-to-female ratio of 2.5:14.
Siblings of affected individuals have up to a thirtyfold increase
in the risk of clubfoot deformity. Clubfoot affects both siblings
in 32.5% of monozygotic twins but in only 2.9% of
dizygotic twins5. Lochmiller et
al. reported that 24.4% of affected individuals have a
family history of idiopathic talipes equinovarus 4.
Histologic Anomalies
Almost every tissue in the clubfoot has been described as being abnormal6.
Ultrastructural muscle abnormalities were identified by Isaacs et
al.7. Handelsman and Badalamente demonstrated an increase in . . . [Full Text of this Article]
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