Over the past 7 years, we have reviewed numerous research publications on Clubfoot or Congenital Talipes Equinovarus. Initially, much of the material was challenging, but each study contributed to our understanding of this complex condition and combining the insights with a decent amount of patient feedback and outcomes allows us to analyze studies in more detail than before.
Over the years, we've found several papers on clubfoot histology. Surprisingly, the name 'Clubfoot' doesn't fully capture the condition's impact, as etiology studies show it affects more than just the foot, with changes sometimes visible throughout the entire leg under a microscope.
The hands, hips, and knees can also be affected. Publications from the 70s and 80s report that calf muscles are smaller or show hypoplasia in unilateral cases compared to the healthy side. Adult clubfoot patients frequently report muscle atrophy.
Isaacs et al. (1977) concluded that the fibers were "grossly abnormal" and found disrupted nerve connections in calf muscles. Fukuhara et al. discovered that bone malformations were secondary to changes in ligament and collagen soft tissue.
Adult patients experience muscle weakness and relapses. A 1998 study by Loren et al. found that skeletal muscles crucial for movement are affected in 20% of cases, with about 50% showing abnormal muscle morphology. An MRI study reported calf muscle atrophy in a 2-year-old. In 1980, Ippolito and Ponseti's study of 5 clubfeet and 3 normal feet identified altered tarsal bone characteristics, reduced muscle fibers in the leg's posterior and medial aspects, increased fibrous tissue, and triceps surae shortening.
Some papers reported minor muscle or tissue differences, with post-treatment studies lacking tissue histology reporting. Neurologic deficits has been suggested as a recurrence cause, see Thometz et al:2011 in the study "Electromyography Nerve Conduction Velocity Evaluation of Children With Clubfoot". Researchers found that 20% of non-surgery patients showed neuropathic evidence, which increased to 57% after surgery. Peroneal mononeuropathy was the most common disorder, affecting 41% of surgery patients.
Recurrence of the deformity happens in both surgical and non-surgical treated feat though per adult patient feedback captured on social media reports. Thus neurological effects such as peroneal nerve damage seems to be a problem congenitally and in acquired situations.
From these resources much more than just the foot and its appearance are affected which means that the name of the condition is not really descriptive of the condition and may even be misleading in a sense because it does not capture the true nature of the condition.
We have not been able to find online in any article thus far, where this name 'Clubfoot' was chosen. All we could find is that this condition appears in animals as well and thus it is named clubfoot based on a similar condition appearing in horses, sloths, mice and chickens...but is it necessarily the same thing?
