History and exam
Key diagnostic factors
common
positive family history
equinus deformity
The foot is in fixed equinus and cannot be dorsiflexed.[21]
hind foot in varus and adducted
The hind foot is in varus and adducted.[21]
forefoot adducted
The forefoot is adducted and in relative pronation to the hind foot, resulting in a twisting of the foot.[21] The foot appears to be in an upside-down posture.
Other diagnostic factors
common
hip dysplasia
Evidence regarding the association between clubfoot and developmental dysplasia of the hip is equivocal.[23][24][25] The incidence of hip dysplasia is higher in other foot deformities such as metatarsus adductus and calcaneal valgus deformities. The British Society for Children’s Orthopaedic Surgery (BSCOS) Clubfoot Consensus Group has recommended that all babies with a clubfoot deformity should receive a screening ultrasound scan of their hips.[22]
Positive Barlow and Ortolani tests are diagnostic for hip dysplasia in newborns; limited abduction is seen in older toddlers.
uncommon
neurologic or chromosomal abnormalities
Various neuromuscular-type diseases are associated with clubfoot, including arthrogryposis, cerebral palsy, diastrophic dysplasia, polio, spina bifida, and syndromes such as amniotic band, Down, Freeman-Sheldon, or Mobius.[29]
smaller lower extremity
The foot and calf are usually smaller in unilateral cases.
dimpling, hairy patch along spine line
May indicate underlying spinal abnormality.
Risk factors
strong
family history of equinovarus foot deformity
First-degree relatives have an occurrence rate 17 times higher than the general population.[1][2][8][9] Second-degree relatives have an occurrence rate 6 times higher than the general population. Monozygotic twins have a >30% chance of both twins being affected.
These findings have led to the following conclusions: if a male baby is affected, a subsequent brother has a 1 in 42 chance of being affected (lower for a subsequent sister). If a female baby is affected, the chance of being affected is 1 in 16 for a brother and 1 in 40 for a sister. If both a parent and a child have clubfoot, subsequent children have a 1 in 4 chance of having a clubfoot deformity.
associated congenital abnormalities
Various neuromuscular-type diseases are associated with clubfoot, including arthrogryposis, cerebral palsy, diastrophic dysplasia, polio, spina bifida, and syndromes such as amniotic band, Down, Freeman-Sheldon syndrome, or Mobius.[5]
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