It has been 7 years since we started to review various Clubfoot or Congenital Talipes Equinovarus research publications. Back then most of what we read were quite above our heads, but from each paper we were able to take something that shaped and formed our understanding about this very complex condition called Clubfoot. At the very least we are now able to 'get' the gist of most.
Through the years we have found several papers dealing with the histology of clubfoot. What was strange to us after studying these is the name 'Clubfoot'. In the etiology studies it is clear that much more than just the foot is affected by this condition. Sometimes changes are visible up the whole leg under the microscope at least. Sometimes the hands are also affected or the hips and knees. Some of these publications date back to the 70's and 80's. These papers all mention that the calf muscles are smaller or hypoplasia (under or incomplete development of tissues for example reduced fat tissue) are observed, in particular in unilateral cases when compared to the presumed healthy side. Muscle atrophy have been reported by adult clubfoot patients a whole lot.
Some of the authors were Isaacs et al 1977, who concluded that the fibers were different and 'grossly abnormal' plus they found evidence of disruptions of nerve connections to organs or parts in the calf muscles. Fukuhara et al. found that bone malformations were secondary to soft tissue changes in ligament and collagen.
Adult patients report muscle weakness and relapses. Another study in 1998 by Loren et al. concluded that skeletal muscles that is important for movement are affected in 20% of the cases and that in total about 50% of the cases demonstrated abnormal muscle morphology. In one MRI case that we have had access to the MRI showed the calf muscle of a 2 year old was found to be atrophied.
In 1980, a small study of 5 clubfeet and 3 normal feet by Ippolito and Ponseti found that "1. Altered shape, size and relationships of the tarsal bones. 2. Decrease in the size and number of fibers in the distal third of the muscles of the posterior and medial aspect of the leg; increased fibrous connective tissue in these muscles, their tendon sheaths, and the adjacent fasciae; and shortening of the triceps surae," and the list goes on...
There has been a paper or two that reported less significance in terms of muscle or tissue differences. Post treatment studies have been few and definitely did not include any histology of tissue structures. Neurologic deficit has been mentioned as a possible cause for recurrence in the past and this evidence was further supported by Thometz et al. in 2011, with a study called, "Electromyography Nerve Conduction Velocity Evaluation of Children With Clubfoot".
These researchers found that in non-surgery treated patients about 20% presented with neuropathic evidence and after surgery the percentage increased to 57%!. More 'specifically, peroneal mononeuropathy was the most common disorder' (41% of patients that underwent surgery).
Recurrence of the deformity happens in both surgical and non-surgical treated feat. Peroneal nerve damage seems to be a problem in both groups.
From these resources it is clear that much more than just the foot and it's appearance are affected by this condition which means that the name of the condition is quite misleading in a sense. It does not provide insight into the true nature of the condition. We have not been able to find online in any article thus far, where this name was chosen and by whom? All we could find is that this condition appears in animals as well and thus it is named clubfoot.
