Congenital clubfoot | Lower leg muscles

Congenital clubfoot

The congenital clubfoot, also Pes equinovarus, is a malposition of the child’s foot and occurs with a frequency of 1:1000 births. Boys are affected twice as frequently as girls. The cause of the foot deformity is a disturbance of the balance of the lower leg muscles, in which plantar flexors, i.e. flexors of the foot towards the sole of the foot, and supinators, lifts of the middle edge of the foot, predominate.

The “clubfoot muscle” is also called the posterior tibial muscle, which brings the foot into supination and bends it towards the sole of the foot. The malposition exists directly at birth and is a combination of several deformities. Usually, an inward rotation of the foot, the sickle-foot position of the forefoot, pointed foot, hollow foot and a lateral deviation of the heel come together.

The exact origin of the congenital clubfoot is not yet clear. However, it is assumed that the position of the embryo in the uterus is a decisive factor. A reduced amount of amniotic fluid could also promote the development of a clubfoot.

As a result of a neural tube defect, the faulty formation of the embryonic attachment of the central nervous system, paralysis of the lower leg muscles can occur, leading to the development of a clubfoot.It is also being discussed whether congenital clubfoot can occur in the fourth to twelfth week of pregnancy as a result of taking folic acid antagonists such as Aminopterin® or Methotrexat®. Treatment should be initiated immediately after birth. Initially, the therapy consists of the fixation of the foot, the so-called retention, which is gradually adapted to a correct position (redressement).

The plaster cast must be changed regularly and the redressement is continued. At the age of about three months, an operation on the Achilles tendon may become necessary, whereby the tendon is lengthened and the angle between the ankle and heel bone is corrected. Further measures may include transplantation of the anterior tibial muscle, bone corrections or joint stiffening. In order to stretch shortened muscles and mobilize the joints of the foot, physiotherapeutic procedures should be used early on, since in the long term a renewed deviation into the malposition can occur.