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Pathoanatomy of Congential Clubfoot

- See: Congential Clubfoot Menu:

- Clinical Anatomy:
    - affected limb may be shortened, calf muscle is atrophic, and foot is short compared to opposite side;
    - medial rotation of tibia;
    - joints:
           - ankle and subtalar joints are in fixed equinus;
           - posterior displacement of lateral malleolus: (assess with patient prone and knee flexed to 90 degrees)
           - hindfoot:
                  - heel is inverted (varus)
                  - talus lies in a position of equinus, medial rotation (in the ankle mortise);
                         - its head is palpable at sinus tarsi;
                         - pronounced medial angulation of head and neck of talus;
                  - calcaneus is in equinus, varus, and is rotated internally;
                  - w/ more severe deformity, calcaneus may be difficult to palpate (because of the underlying fatty tissue);
           - midfoot:
                  - no midtarsal mobility;
                  - medial or transverse midfoot crease (indicates more severe deformity)
                  - navicular displaced medially, and may abut the medial malleolus;
                  - cuboid is medially displaced in relation to the long axis of the calcaneus (but to lesser degree than the navicular);
                  - os calcis fixed to fibula
                  - curved lateral foot border
           - forefoot:
                  - forefoot and midfoot are inverted and adducted
                  - forefoot cavus w/ depressed 1st metatarsal;
                  - fixed forefoot supination relative to the hindfoot (forefoot varus);
    - tendons and ligament contractures:
           - contracture of Achilles
           - tibialis posterior;
           - plantar aponeurosis;
           - abductor hallucis;
           - FDB (causing a cavus deformity of foot);
           - long toe flexor tendons;
           - ext. digitorum longus
           - tibialis anterior
           - extensor hallucis longus
           - contractures of spring, bifurcate, deltoid, calcaneofibular, talofibular ligaments;
                  - calcaneonavicular (spring ligament): runs from sustenaculum tali to plantarmedial aspect of navicular;
           - Master Knot of Henry:
                  - fibrous slip that envelops the FHL and FDL tendons;
                  - binds the plantar medial surface of the navicular;
    - vascular exam:
           - note that the dorsalis pedis artery is frequently not present in club foot and therfore special care
                  must be taken to avoid injury to the posterior tibial artery during a posteromedial release;
    - reference:
           - Clubfoot: its pathological anatomy.  

Clubfoot References