Clubfoot what we need to know ? an uncommon foetal abnormality detected in sonography at 18 weeks of pregnancy

Clubfoot is a congenital malformation of the bones of the ankle and foot resulting in the adduction of the forefoot in ersion ofnthe heel and plantar flexion of the forefoot and ankle .There is subluxation of the talo calcaneo- navicular joint . As a result of this malformation the dorsal aspect of the foot is often rotated medially which assumes a clublike appearance.The aonographic diagnosis is made when the metatarsals and phalanges of the foot are seen in the same plane as the tibia and fibula. The severity of the clubfoot deformity varies from a postural deformity often requirimg no treatme t an isolated clubfoot deformity needing casting amd possible surgery often with a favourable outcome or a complex clubfoot abnormality associated with other chromosomal neuro muscular or structural abnormalities. Clubfoot may also result from restriction of movement inutero as in severe oligohydramnios. The prevalence is often stated as one per 1000 live births with a 2:1 male to female predisposition .Several series have demonstrated that an initially diagnosed isolated clubfoot abnormality was noted to be complex and associated with other abnormalities either later in pregnancy or in the neonatal period.

False positive diagnose are more prevalent when unilateral clubfoot is suspect than when bilateral clubfoot was suspect or diagnosed. The association of an isolated clubfoot abnormality with aneuploidy is controveesial .Shipp and Benacerraf found that 5.9% of 87 fetuses with isolated clubfoot had an abnormal kaeyotype and concluded that amniocentesis is indicated after that diagnosis .Other imvestigators came to the opposite conclusion .In the series by Malone et al there were no cases aneuploidy on karyotype when the clubfoot was isolated.