Imaging description

A 16-month-old girl with bilateral foot deformities since birth had radiographs that demonstrated marked hindfoot and forefoot varus abnormalities bilaterally consistent with bilateral clubfeet (Fig. 82.1a). The talocalcaneal angles measured 0 degrees bilaterally on AP radiographs. The angle between the talus and the first metatarsal measured more than 20 degrees. Lateral views of both feet demonstrated decreased talocalcaneal angles bilaterally. In addition, the right foot demonstrated a fixed hindfoot equinus deformity (plantar flexed calcaneus) whereas the left calcaneus was able to be forcibly dorsiflexed (Fig. 82.1b).

Importance

Clubfoot (talipes equinovarus) is a congenital deformity consisting of hindfoot equinus, hindfoot varus (inversion), and forefoot varus (adduction) deformities. Clubfoot deformities affect three joints of the foot to varying degrees, including inversion of the subtalar joint, adduction of the talonavicular joint, and plantarflexion of the calcaneus relative to the tibia, resulting in “toe walking.” Clubfoot deformities can involve one foot or both. Bilateral involvement is found in 30–50% of cases. Clubfoot deformities can be classified as either postural or structural. Postural or positional clubfoot is not defined as true clubfoot. Structural clubfoot can be subdivided into either a flexible type, which is correctable without surgery, or a resistant type, which requires surgical release.