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Talipes Equinovarus epidemiology

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  #1  
Old 29th June 2010, 01:17 PM
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Default Talipes Equinovarus epidemiology

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Epidemiology of congenital idiopathic talipes equinovarus in Iowa, 1997-2005.
Kancherla V, Romitti PA, Caspers KM, Puzhankara S, Morcuende JA.
Am J Med Genet A. 2010 Jun 25;152A(7):1695-1700. [Epub ahead of print]
Quote:
Congenital idiopathic talipes equinovarus (ITEV), also known as clubfoot, is a well-recognized foot deformity. To date, prevalence estimates and descriptive data reported for ITEV have varied due to differences in study methodology. Using population-based surveillance data collected by the Iowa Registry for Congenital and Inherited Disorders, we examined isolated ITEV births delivered from 1997 through 2005 and compared to live births in Iowa during the same time period. An overall prevalence was calculated for live, singleton full-term births only. Prevalence odds ratios (POR)s and 95% confidence intervals (CI)s were examined for selected infant and parental characteristics. The prevalence of isolated ITEV was 11.4 per 10,000 live, singleton full-term births (95% CI = 10.3, 12.6), with no significant variation in prevalence during the study period. Increased PORs were found for males (POR 1.8; 95% CI = 1.5, 2.3) and maternal smoking during pregnancy (POR = 1.5, 95% CI = 1.2, 1.9); low birth weight (<2,500 g) showed an increase among females (POR = 3.2, 95% CI = 1.5, 6.9) but not males (POR = 0.9, 95% CI = 0.3, 2.8). Elevated, but non-significant, PORs were found for season of birth, maternal education, and trimester prenatal care was initiated; decreased PORs were found for fetal presentation, maternal race/ethnicity, parity, area of residence, and parental age at delivery. Our study of a well-defined, homogenous sample suggested that prevalence of isolated ITEV in Iowa was similar to that reported in other population-based studies and provided support for some, but not all, previously reported associations with infant and parental characteristics. More detailed, longitudinal studies of isolated ITEV are recommended.
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Old 3rd November 2010, 03:58 PM
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Default Re: Talipes Equinovarus epidemiology

Incidence of clubfoot in Uganda.
Mathias RG, Lule JK, Waiswa G, Naddumba EK, Pirani S.
Can J Public Health. 2010 Jul-Aug;101(4):341-4.
Quote:
BACKGROUND: While the congenital clubfoot deformity is a common deformity recorded in Uganda, the incidence of the condition had never been accurately determined. The objective of this study was to measure the overall incidence of congenital clubfoot deformity in a representative sample of births.

METHODS: A study of all babies born with foot anomalies took place from March 2006 to October 2007. The study was based at 8 Regional Hospitals with active maternity units and a functioning clubfoot clinic. All babies with foot deformities at birth at any of eight centres as detected by the delivery room staff were referred to the respective centre's clubfoot clinic. The children were examined by clubfoot clinic orthopedic officers who diagnosed the specific deformity. Children referred to the clinic from any source and born at the maternity unit were included in the study. The denominator was all live births at the centre during the study period.

RESULTS: The total number of live births during the study period was 110,336. The maternity units of the centres identified 290 infants with a foot deformity. One hundred and thirty infants born during the study period were diagnosed in the clubfoot clinic as having a congenital clubfoot deformity. The proportion of infants with a clubfoot deformity was 1.2 per 1000 births over the 20-month period. The male to female ratio was 2.4:1.

RECOMMENDATION: The rate of clubfoot deformities in the newborn can be used to estimate the numbers of children who should be treated and to estimate resource needs for the identification and management of this treatable congenital malformation. By comparing the number of those treated with the expected number of cases, the numbers of children with neglected clubfoot can be calculated.
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Old 1st May 2013, 04:24 PM
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Default Re: Talipes Equinovarus epidemiology

Demographics of Children Attending Clubfoot Clinics at Two Academic Hospitals
SP Swai, G Firt
Bone Joint J 2013 vol. 95-B no. SUPP 14 70
Quote:
Purpose of Study The management of idiopathic clubfoot has changed substantially over the past fifty years with the Ponseti method of treatment gaining increasing popularity in recent years. The advantages of this method are its simplicity and minimal resource requirements with high published success rates. One of the disadvantages is that unless treatment protocols are meticulously adhered to, especially in the bracing stage, recurrence will occur. This study explores the demographics and highlights existing barriers to successful clubfoot treatment outcomes at two academic hospitals.

Description of Methods A cross sectional study was conducted of all children undergoing clubfeet treatment between June and December 2011. A stratified questionnaire was used at two academic hospitals.

Summary of Results A total of 135 children were included, 49 (36.3%) female and 86 (63.7%) male. Over 98% of the children were born in hospital. Fifty five children, (40.8%, almost half), travelled over 30 km to attend the clinic every week. One hundred and thirteen children (83.7%) made use of public transport. Most parents (83 children, 63.7%)had secondary school education. The majority of families, 111 children (82.2%), had a combined household income of less than R2000 per month. Sixty four children (47.4%) received a child dependency grant.

Conclusion The majority of children attending these two clubfoot clinics came from households earning less than R2000 a month and almost half of them travelled more than 30 km a week to attend the clubfoot clinic. Outreach programmes and satellite clinics with properly trained staff for the management of clubfoot are desperately needed in Gauteng Province to ease the burden on the families of children with clubfeet and facilitate compliance with treatment.
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Old 22nd May 2013, 08:44 PM
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Default Re: Talipes Equinovarus epidemiology

Descriptive Epidemiology of Idiopathic Clubfoot
Martha M. Werler et al
American Journal of Medical Genetics Part A; Early View
Quote:
Clubfoot is a common structural malformation, occurring in approximately 1/1,000 live births. Previous studies of sociodemographic and pregnancy-related risk factors have been inconsistent, with the exception of the strong male preponderance and association with primiparity. Hypotheses for clubfoot pathogenesis include fetal constraint, Mendelian-inheritance, and vascular disruption, but its etiology remains elusive. We conducted a population-based case–control study of clubfoot in North Carolina, Massachusetts, and New York from 2007 to 2011. Mothers of 677 clubfoot cases and 2,037 non-malformed controls were interviewed within 1 year of delivery about socio-demographic and reproductive factors. Cases and controls were compared for child's sex, maternal age, education, cohabitation status, race/ethnicity, state, gravidity, parity, body mass index (BMI), and these pregnancy-related conditions: oligohydramnios, breech delivery, bicornuate uterus, plural birth, early amniocentesis (<16 weeks), chorionic villous sampling (CVS), and plural gestation with fetal loss. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for state. Cases were more likely to be male (OR: 2.7; 2.2–3.3) and born to primiparous mothers (1.4; 1.2–1.7) and mothers with BMI ≥30 kg/m2 (1.4; 1.1–1.8). These associations were greatest in isolated and bilateral cases. ORs for the pregnancy-related conditions ranged from 1.3 (breech delivery) to 5.6 (early amniocentesis). Positive associations with high BMI were confined to cases with a marker of fetal constraint (oligohydramnios, breech delivery, bicornuate uterus, plural birth), inheritance (family history in 1st degree relative), or vascular disruption (early amniocentesis, CVS, plural gestation with fetal loss). Pathogenetic factors associated with obesity may be in the causal pathway for clubfoot
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Old 2nd September 2013, 02:18 PM
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Default Re: Talipes Equinovarus epidemiology

Prevalence of developmental dysplasia of the hip in children with clubfoot
Daud TS Chou, Manoj Ramachandran \
Journal of Children's Orthopaedics; August 2013
Quote:
Purpose
The relationship between congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip (DDH) remains uncertain. The role of routine hip screening in children with CTEV is debated. A recent study has found a high incidence of DDH in patients with CTEV. The aim of our study was to determine the true prevalence of radiographic hip dysplasia and identify the need for routine hip screening in patients treated for CTEV.

Methods
From a single centre database of 165 children consisting of 260 CTEV, a prospective radiological prevalence study of 101 children was performed over a period of 3 months. A single anterior-posterior pelvic radiograph was performed at a minimum age of 5 months. The DDH was determined by a single senior investigator based on the age-adjusted acetabular index (AI) as described by Tonnis.

Results
There were no dislocations or subluxations. According to the age-adjusted AI, 16 children had ‘light’ dysplasia and one child had ‘severe’ dysplasia. The child with severe dysplasia was known to have DDH and had already undergone treatment. The 16 children with light dysplasia did not require any form of treatment.

Conclusion
Out of one hundred and one children with CTEV, only one had DDH requiring treatment. This is consistent with the majority of the literature supporting the premise that there is no true association between CTEV and DDH. We, therefore, feel that routine hip screening for children with CTEV is not supported by current evidence and cannot be recommended.
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Old 13th September 2013, 11:59 PM
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Default Re: Talipes Equinovarus epidemiology

Is it worthwhile to screen the hip in infants born with clubfeet?
Dahang Zhao, Weiwei Rao, Li Zhao, Jianlin Liu, Yaqing Chen, Pinquan Shen, Qing Du, Luan Li
International Orthopaedics; September 2013
Quote:
Purpose
There is some disagreement about whether idiopathic congenital talipes equinovarus (CTEV) increases the risk of neonatal developmental dysplasia of the hip (DDH). This study aimed to investigate the incidence of DDH in our infants with idiopathic CTEV.

Methods
We conducted an observational cohort study over a three-year period to assess the relationship between idiopathic CTEV and DDH. All neonates younger than six weeks with idiopathic CTEV who were treated in our medical centre were admitted to this study. Each subject underwent hip ultrasound examination using the Graf method at the age of six weeks. DDH was diagnosed when a hip was type IIa(−) or worse according to the Graf classification of sonographic hip type.

Results
A total of 184 patients were diagnosed with idiopathic CTEV and underwent hip sonography. In total, seven hips of five individuals underwent treatment (four girls and one boy). The results indicated that 2.7 % of babies (five of 184) with idiopathic CTEV had DDH. However, we did not find any statistically significant difference (p = 0.5776) in the Pirani scores between the DDH group and group with normal hips.

Conclusions
This study revealed that the idiopathic CTEV group had a greater incidence of DDH in comparison with the general population. It is recommended that hip sonography be undertaken particularly in patients with idiopathic CTEV.
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Old 23rd September 2013, 03:12 PM
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Default Re: Talipes Equinovarus epidemiology

Evaluation of online health information on clubfoot using the DISCERN tool.
Kumar VS, Subramani S, Veerapan S, Khan SA
Journal of Pediatric Orthopedics. Part B [2013]
Quote:
The Internet has become a major source of health information on various aspects of clubfoot diagnosis and management. The World Wide Web becomes the first knowledge portal for a large number of anxious parents seeking information on clubfoot. Thus, a good quality webpage should provide necessary and comprehensive information on clubfoot so as to establish clarity in treatment options, compliance and bracing protocols. In contrast, modest quality information can induce bias and poor follow-up. We objectively evaluated online health information on clubfoot using the DISCERN tool. Using the universal search engine, Google, we conducted a Boolean search for the term 'clubfoot'. Only the first 50 sites providing health information on clubfoot were included in the study. We examined 334 links to include 50 of them. During analysis three websites were excluded because of duplication of content leaving 47 websites that were examined using the DISCERN tool. As per this tool, a score of less than 40% was graded as 'poor', 40-79% as 'fair' and at least 80% as 'good', whereas the overall quality was graded as 'low', 'moderate' and 'high' on similar standards. The overall quality of the publication was 'low' in 40% (19) websites, 'moderate' in 28% (13) and 'high' in 32% (15) of the websites we evaluated. Six (13%) of the publications showed good reliability; 25 (54%) showed fair reliability and 16 (33%) were unreliable. With regard to the quality of information on treatment choices, 44.7% (21) were 'good', 46.8% (22) were 'fair' and 8.5% (four) were 'poor'. We conclude that the quality of websites providing online health information on clubfoot needs significant improvement with emphasis on a universally acceptable template for disease information.
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Old 30th September 2013, 04:59 PM
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Default Re: Talipes Equinovarus epidemiology

An descriptive epidemiological study on congenital clubfoot in China during 2001 to 2010
Yi L, Zhou GX, Dai L, Li KS, Zhu J, Wang Y
Journal of Sichuan University. Medical Science Edition [2013, 44(4):606-609]
Quote:
OBJECTIVE: To understand the trend of prevalence of congenital clubfoot and its epidemiological characterisitics in China during 2001 to 2010.

METHODS: The data of the perinatal children with congenital clubfoot from 2001 to 2010 in the birth defects monitoring program were collected and analyzed, and the perinatal children were defined from the pregnancy of 28 weeks to postnatal 7 days, including live births, fetal deaths and stillbirths. SPSS16.0 software was used to analyze the data.

RESULTS: A total of 4,233 cases were identified with congenital clubfoot among 8 273 382 births, with a prevalence of 5.12/10(4). There was no increasing trend or decreasing trend on the prevalence of congenital clubfoot to be found in China during 2001 to 2010 (chi2 = 2. 43, P > 0.05). The prevalence of congenital clubfoot in urban and rural areas was 4.90 and 5.43 per 10 000 births respectively. The prevalence of congenital clubfoot in male and female babies was 5.31 and 4.3 per 10,000 births respectively. The prevalence of congenital clubfoot in west, middle and east region was 7.00, 4.52 and 4.27 per 10,000 births respectively. The prevalence of congenital clubfoot in south and north region was 5. 82 and 4. 34 per 10,000 births respectively. The difference between them is statistically significant (P < 0.05). The distribution of affected area between male and female was not significantly different (chi2 = 1.74, P < 0.05).

CONCLUSION: There was no increasing or decreasing trend on the prevalence of congenital clubfoot to be found in China during 2001 to 2010. The prevalence of congenital clubfoot in China was found with regional differences and gender differences. The prevalence of congenital clubfoot in Chinese population is greater than foreign populations.
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Old 15th October 2013, 08:16 PM
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Default Re: Talipes Equinovarus epidemiology

Prospective Evaluation of a Prenatal Sonographic Clubfoot Classification System
Glotzbecker M.P. · Estroff J.A. · Curtis T.A. · Kalish L.A. · Spencer S.A. · Parad R.B. · Kasser J.R. · Mahan S.T.
Fetal Diagn Ther (DOI: 10.1159/000354554)
Quote:
Background: The purpose of this study was to prospectively evaluate our recently described fetal sonographic classification system for prenatal diagnosis of clubfoot.

Methods: Over 18 months, we prospectively enrolled consecutive pregnant patients evaluated for a prenatally diagnosed clubfoot. Prenatal sonographic scores assigned by a radiologist were compared to final clinical diagnosis and severity given by a pediatric orthopedic surgeon. Pearson's χ2 test and logistic regression were used in statistical analyses on the subject level. Generalized estimating equations were used in analyses on the foot level to account for intrasubject correlation.

Results: There were 50 subjects, with 26 unilateral and 24 bilateral clubfeet, according to the prenatal ultrasound (US). A total of 51 (69%) of 74 feet and 36 (72%) of 50 subjects had a postnatal diagnosis of clubfoot. The accuracy of diagnosis in cases of a severe, moderate, and mild US score was 94, 70, and 25%, respectively (p = 0.003 comparing moderate-severe vs. mild). US severity correlated with the Dimeglio classification scoring system (Spearman's correlation 0.30).

Conclusion: The fetal sonographic scoring system is predictive of clinical severity after birth, and improves the ability to counsel families with a prenatal diagnosis of clubfoot
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Old 22nd October 2013, 12:22 AM
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Default Re: Talipes Equinovarus epidemiology

Clubfoot Image Classification
Amanda Marie De Hoedt
University of Iowa Masters Thesis 2013 (pdf)
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Old 4th November 2013, 08:44 PM
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Default Re: Talipes Equinovarus epidemiology

Is It Worthwhile to Routinely Ultrasound Screen Children With Idiopathic Clubfoot for Hip Dysplasia?
Mahan ST, Yazdy MM, Kasser JR, Werler MM.
J Pediatr Orthop. 2013 Oct 29.
Quote:
PURPOSE::
Patients with idiopathic clubfoot are considered at increased risk for having developmental dysplasia of the hips (DDH). However, the studies showing this association have been relatively small. Many clinicians who treat idiopathic clubfoot routinely screen the hips of these patients with ultrasound or radiograph due to the concerns of increased risk of DDH. We evaluated a large clubfoot population to determine the risk of DDH and compare this to a population of children without clubfoot. We also evaluated if the clubfoot patients found to have DDH would have been discovered by standard DDH screening.

METHODS::
We identified infants in 3 states (MA, NY, NC), who were reported to each state's birth defects registry as having a clubfoot. A second cohort of infants without clubfoot was also identified as a control group. Mothers of these children were contacted to be included in the study, and a computer-assisted telephone interview was administered by one of the study nurses, including questions about treatment of DDH. The child's median age at interview was 7 months. Mothers of clubfoot cases were also contacted for follow-up at mean age of 3.3 years.

RESULTS::
Families of 677 patients with clubfoot and 2037 controls were interviewed. A total of 5/677 (0.74%) patients with clubfoot and 5/2037 (0.25%) controls reported having their infant treated with a brace or harness for hip problems (P=0.134). Of the patients with clubfoot, 2 of them did not need treatment for their DDH and 2 would have been discovered by standard hip screening. Follow-up study at 3.3 years of age found no serious late hip dysplasia.

CONCLUSIONS::
Treatment of DDH was uncommon in all children; the higher proportion in infants with clubfoot was not statistically different than controls. Of the patients with clubfoot and DDH, standard hip screening would have been appropriate and others did not need treatment. These data suggest that routine hip ultrasound or radiographic screening of idiopathic clubfoot patients is not necessary unless indicated by the standard infant hip screening.
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Old 18th November 2013, 07:52 AM
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Default Re: Talipes Equinovarus epidemiology

Clubfoot Care in Low-Income and Middle-Income Countries: From Clinical Innovation to a Public Health Program
Luke Harmer, Joseph Rhatigan
World Journal of Surgery; November 2013
Quote:
Background
Clubfoot occurs in nearly 1 in every 1,000 live births worldwide, representing a significant burden of disease. In high-income countries, an evidence-based treatment protocol utilizing sequential casting was pioneered by Ponseti and has resulted in excellent outcomes among children treated for this condition. However, treatment methods and results of treatment vary greatly across low- and middle-income countries (LMICs). Our goal was to create a framework for understanding how effective programs that treat clubfoot in LMICs choose and organize their activities.

Methods
A systematic literature review was conducted using the keywords “developing countries” and “clubfoot.” A public health analysis model known as the Care Delivery Value Chain (CDVC) was applied to discover public health practices that would optimize value over the entire course of a patient’s life.

Results
The literature review yielded 32 unique results, seven of which met our inclusion and exclusion criteria. Review of the bibliographies yielded two additional papers for a total of nine papers. We identified seven vital steps in the clubfoot cycle of care and constructed a CDVC.

Conclusions
The analysis of this CDVC model suggests six best practices that are essential to successfully scaling up clubfoot treatment programs and ensuring excellent clinical outcomes: (1) diagnosing clubfoot early; (2) organizing high-volume Ponseti casting centers; (3) using nonphysician health workers; (4) engaging families in care; (5) addressing barriers to access; (6) providing follow-up in the patient’s community. These practices must be adapted to each context. Applying them will optimize outcomes when designing public health programs that deliver clubfoot care in LMICs.
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Old 17th January 2014, 10:09 PM
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Default Re: Talipes Equinovarus epidemiology

Prevalence of developmental dysplasia of the hip in children with clubfoot.
Chou DTs, Ramachandran M.
J Child Orthop. 2013 Oct;7(4):263-7
.
Quote:
PURPOSE:
The relationship between congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip (DDH) remains uncertain. The role of routine hip screening in children with CTEV is debated. A recent study has found a high incidence of DDH in patients with CTEV. The aim of our study was to determine the true prevalence of radiographic hip dysplasia and identify the need for routine hip screening in patients treated for CTEV.
METHODS:
From a single centre database of 165 children consisting of 260 CTEV, a prospective radiological prevalence study of 101 children was performed over a period of 3 months. A single anterior-posterior pelvic radiograph was performed at a minimum age of 5 months. The DDH was determined by a single senior investigator based on the age-adjusted acetabular index (AI) as described by Tonnis.
RESULTS:
There were no dislocations or subluxations. According to the age-adjusted AI, 16 children had 'light' dysplasia and one child had 'severe' dysplasia. The child with severe dysplasia was known to have DDH and had already undergone treatment. The 16 children with light dysplasia did not require any form of treatment.
CONCLUSION:
Out of one hundred and one children with CTEV, only one had DDH requiring treatment. This is consistent with the majority of the literature supporting the premise that there is no true association between CTEV and DDH. We, therefore, feel that routine hip screening for children with CTEV is not supported by current evidence and cannot be recommended.
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Old 2nd June 2014, 07:39 PM
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Default Re: Talipes Equinovarus epidemiology

Unilateral versus bilateral clubfoot: an analysis of severity and correlation.
Gray, Kelly; Barnes, Elizabeth; Gibbons, Paul; Little, David; Burns, Joshua
Journal of Pediatric Orthopaedics B: 27 May 2014
Quote:
This study compares the severity of unilateral and bilateral clubfoot, and the correlation between right and left feet of bilateral cases. Sixty-six unilateral and 75 bilateral clubfoot patients were assessed for severity using the Pirani score at an average age of 12.9 days (SD 9 days). In bilateral cases, the severity of right and left feet was highly correlated (r=0.68). The odds of being very severe were 2.6 (95% confidence interval 1.3-5.1) times higher in bilateral cases (P=0.007). Bilateral and unilateral clubfeet present with differing severity. Right and left feet from bilateral cases are highly correlated. Researchers need to address these issues during study design and analysis.
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Old 9th June 2014, 10:34 PM
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Default Re: Talipes Equinovarus epidemiology

The Contralateral Foot in Children with Unilateral Club foot, Is the unaffected side normal?
Anthony Cooper, Christine Alvarez, Harpreet Chhina, Alyssa Howren
Gait & Posture; Available online 5 June 2014
Quote:
Highlights
• Pedobarographic measurements of unilateral unaffected clubfoot are not same as normal controls.
• The unaffected foot should not be referred to as normal, nor should it be used as a control.
• Timings of initiation of stance differ significantly between normal and unaffected clubfeet.
• Unaffected clubfoot accumulates differences from normal feet due to maturation of gait with age.
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Old 1st November 2014, 01:00 PM
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Default Re: Talipes Equinovarus epidemiology

Prevalence and prenatal ultrasound detection of clubfoot in a non-selected population: an analysis of 549,931 births in Tuscany
Viola Seravalli, Anna Pierini, Fabrizio Bianchi, Sabrina Giglio, Francesca Vellucci, and Ettore Cariati
Journal of Maternal-Fetal and Neonatal Medicine
Quote:
Objective To evaluate the prevalence and prenatal ultrasound detection of clubfoot in Tuscany during a period of 20 years.

Methods This is a descriptive analysis on data from the Tuscan register of congenital defects, covering a 20-year period from 1992 to 2011. The Tuscan registry of congenital defects is a population-based register for the epidemiologic surveillance of congenital anomalies. The study included all cases of pre- or postnatally diagnosed clubfoot (isolated clubfoot and cases associated with other congenital defects). Overall prevalence and prenatal detection rates were calculated.

Results Among the 549,931 deliveries recorded in Tuscany between 1992 and 2011, 858 cases of clubfoot were registered, with a prevalence of 1.56/1,000. Seventy-eight percent of cases were isolated. The detection rate was higher when the defect was associated with other anomalies compared to isolated forms. Over the study period, there was a substantial improvement in the prenatal detection of clubfoot (from 11 to 31% overall). For isolated forms, detection rate improved from 4 to 16%, and for cases associated with other congenital defects, it increased from 43 to 73%.

Conclusion
Prevalence of clubfoot in Tuscany is 1.56 per 1,000 births, in agreement with the incidence reported in epidemiological studies in Europe. Prenatal detection of clubfoot improved over time. The detection rate was higher in cases associated with other anomalies.
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Old 8th November 2014, 02:34 AM
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Default Re: Talipes Equinovarus epidemiology

Is congenital talipes equinovarus a risk factor for pathological dysplasia of the hip?
a 21-year prospective, longitudinal observational study

R. W. Paton, Q. A. Choudry, R. Jugdey, S. Hughes
Bone Joint J 2014;96-B:1553–5.
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There is controversy whether congenital foot abnormalities are true risk factors for pathological dysplasia of the hip. Previous United Kingdom screening guidelines considered congenital talipes equinovarus (CTEV) to be a risk factor for hip dysplasia, but present guidelines do not. We assessed the potential relationship between pathological dysplasia of the hip and fixed idiopathic CTEV.

We present a single-centre 21-year prospective longitudinal observational study. All fixed idiopathic CTEV cases were classified (Harrold and Walker Types 1 to 3) and the hips clinically and sonographically assessed. Sonographic Graf Type III, IV and radiological irreducible hip dislocation were considered to be pathological hip dysplasia.

Over 21 years there were 139 children with 199 cases of fixed idiopathic CTEV feet. Sonographically, there were 259 normal hips, 18 Graf Type II hips, 1 Graf Type III hip and 0 Graf Type IV hip. There were no cases of radiological or sonographic irreducible hip dislocation.

Fixed idiopathic CTEV should not be considered as a significant risk factor for pathological hip dysplasia. This conclusion is in keeping with the current newborn and infant physical examination guidelines in which the only risk factors routinely screened are family history and breech presentation. Our findings suggest CTEV should not be considered a significant risk factor in pathological dysplasia of the hip.
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Old 20th November 2014, 08:12 PM
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Default Re: Talipes Equinovarus epidemiology

Congenital Talipes Equinovarus: Frequency of Associated Malformations not Identified by Prenatal Ultrasound
M. Hassan Toufaily, Marie-Noel Westgate and Lewis B. Holmes
Prenatal Diagnosis; Accepted Article
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OBJECTIVES
To establish the frequency of prenatally undetected associated malformations (identified at birth) in infants with apparent “isolated” club foot deformity.

METHODS
A cohort study of all infants with unilateral or bilateral club foot deformity identified at birth among 311,480 infants surveyed between 1972 and 2012 at Brigham and Women's Hospital in Boston. Those with talipes equinovarus were divided into “isolated” and “complex”, based on the findings in examination and by chromosome analysis.

RESULTS
142 infants had “isolated” talipes equinovarus (TEV) and 66 had the “complex” type. Six (4.2%) of the 142 infants with “isolated” TEV were found at birth to have associated malformations that had not been identified by imaging during pregnancy. These abnormalities included hip dislocation (n = 2), bilateral post-axial polydactyly of the feet (n = 1), penile chordee (n = 1), and hypospadias (n = 2).

CONCLUSION
In this consecutive series of infants with isolated talipes equinovarus, 95.8% had no additional malformations identified by examination at birth. None of the additional findings were severe enough to affect the medical prognosis of the affected infant.
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