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Cai M, Lin J, Que Y, Xu L, Lin N, Huang H. Fetal congenital talipes equinovarus: genomic abnormalities and obstetric follow-up results. J Matern Fetal Neonatal Med 2024; 37:2299113. [PMID: 38151241 DOI: 10.1080/14767058.2023.2299113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The etiology of congenital talipes equinovarus (CTEV) is unknown, and the relationship between chromosome microdeletion/microduplication and fetal CTEV is rarely reported. In this study, we retrospectively analyzed fetal CTEV to explore the relationship among the CTEV phenotype, chromosome microdeletion/microduplication, and obstetric outcomes. METHODS Chromosome karyotype analysis and single nucleotide polymorphism (SNP) array were performed for the 68 fetuses with CTEV. RESULTS An SNP array was performed for 68 fetuses with CTEV; pathogenic copy number variations (CNVs) were detected in eight cases (11.8%, 8/68). In addition to one case consistent with karyotype analysis, the SNP array revealed seven additional pathogenic CNVs, including three with 22q11.21 microdeletions, two with 17p12p11.2 microduplications, one with 15q11.2 microdeletions, and one with 7q11.23 microduplications. Of the seven cases carrying pathogenic CNVs, three were tested for family genetics; of these, one was de novo, and two were inherited from either the father or mother. In total, 68 fetuses with CTEV were initially identified, of which 66 cases successfully followed-up. Of these, 9 were terminated, 2 died in utero, and 55 were live births. In 9 cases, no clinical manifestations of CTEV were found at birth; the false-positive rate of prenatal ultrasound CTEVdiagnosis was thus 13.6% (9/66). CONCLUSION CTEV was associated with chromosome microdeletion/microduplication, the most common of which was 22q11.21 microdeletion, followed by 17p12p11.2 microduplication. Thus, further genomic detection is recommended for fetuses with CTEV showing no abnormalities on conventional karyotype analysis.
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Affiliation(s)
- Meiying Cai
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Jiansong Lin
- Department of Pathology, Fujian Maternal and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yanting Que
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Hailong Huang
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
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Johansson A, Wallander H, Esbjörnsson AC. Initial clubfoot treatment in Sweden from 2016 to 2019: A national register study. PLoS One 2024; 19:e0305900. [PMID: 38924021 PMCID: PMC11207129 DOI: 10.1371/journal.pone.0305900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND This study aimed to describe the initial treatment of clubfoot deformity in Sweden using a national cohort. Secondarily we aimed to analyse the results of the initial treatment in relation to foot severity and additional diseases. METHODS A national register, the Swedish Pediatric Orthopedic Quality Register, was used to extract data on children born with clubfoot in 2016-2019. Children with a registered evaluation after initial treatment were included. Data on deformity severity (Pirani score), casting treatment, and achillotenotomy were extracted. For children with bilateral clubfeet, one foot was included in the analysis. RESULTS A total of 565 children were included in the analysis. Of these, 73% were boys and 47% had bilateral clubfeet. Children with isolated clubfoot required a median of six casts to correct the deformity, while children with non-isolated clubfoot needed a median of eight casts. Seventy-seven percent underwent an achillotenotomy. Residual deformities of 0.5 or above (often soft-tissue issues) according to the Pirani score were noted in 23% (isolated clubfoot) and 61% (non-isolated clubfoot) after initial treatment. CONCLUSIONS We have described the initial clubfoot treatment of children born with isolated or non-isolated clubfoot in Sweden based on data from a national register. The initial treatment was performed to a large extent according to the Ponseti method and international recommendations. Moreover, we discuss the usefulness of the Pirani score in classifying clubfoot deformity after treatment.
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Affiliation(s)
- Arne Johansson
- Department of Orthopaedics, Skaraborg Hospital, Skövde, Sweden
| | - Henrik Wallander
- Departments of Orthopedic Surgery, Gävle Hospital, Gävle, Sweden
| | - Anna-Clara Esbjörnsson
- Department of Clinical Sciences Lund, Orthopaedics, Skane University Hospital, Lund University, Lund, Sweden
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Naili JE, Lindeberg M, Esbjörnsson AC. Duration and outcome of orthotic treatment in children with clubfoot - a four-year follow-up national register study of Swedish children born between 2015 and 2017. BMC Musculoskelet Disord 2024; 25:425. [PMID: 38822269 PMCID: PMC11143618 DOI: 10.1186/s12891-024-07544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The Ponseti method for treating clubfoot consists of initial treatment with serial casting accompanied by achillotenotomy if needed, followed by the maintenance phase including treatment with a foot abduction orthosis (FAO) for at least four years. This study aimed to examine the duration, course, and outcome of orthotic treatment in children with clubfoot. METHODS 321 children with clubfoot, born between 2015 and 2017, registered in the Swedish Pediatric Orthopedic Quality Register (SPOQ), were included in this prospective cohort study. Data on deformity characteristics and orthotic treatment were extracted. For children with bilateral clubfoot, one foot was included in the analysis. RESULTS Of the 288 children with isolated clubfoot, 274 children (95.5%) were prescribed an FAO, and 100 children (35%) changed orthosis type before 4 years of age. Of the 33 children with non-isolated clubfoot, 25 children (76%) were prescribed an FAO, and 21 children (64%) changed orthosis type before 4 years of age. 220 children with isolated clubfoot (76%), and 28 children with non-isolated clubfoot (84%) continued orthotic treatment until 4 years of age or longer. Among children with isolated clubfoot, children ending orthotic treatment before 4 years of age (n = 63) had lower Pirani scores at birth compared to children ending orthotic treatment at/after 4 years of age (n = 219) (p = 0.01). It was more common to change orthosis type among children ending orthotic treatment before 4 years of age (p = 0.031). CONCLUSIONS The majority of children with clubfoot in Sweden are treated with an FAO during the maintenance phase. The proportion of children changing orthosis type was significantly greater and the Pirani score at diagnosis was lower significantly among children ending orthotic treatment before 4 years of age. Long-term follow-up studies are warranted to fully understand how to optimize, and individualize, orthotic treatment with respect to foot involvement and severity of deformity. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Josefine Eriksson Naili
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
- Motion Analysis Lab, Karolinska University Hospital, Stockholm, Sweden.
| | - Malin Lindeberg
- Department of Orthopedics, Skane University Hospital, Lund, Sweden
| | - Anna-Clara Esbjörnsson
- Department of Clinical Sciences and Infectious Diseases, Skane University Hospital, Lund University, Lund, Sweden
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Milanovic F, Ducic S, Jankovic M, Sindjic-Antunovic S, Dubljanin-Raspopović E, Aleksic M, Djuricic G, Nikolic D. Clinical Characteristics and Whole Exome Sequencing Analysis in Serbian Cases of Clubfoot Deformity-Single Center Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:647. [PMID: 38929227 PMCID: PMC11201961 DOI: 10.3390/children11060647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/09/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Recognized as one of the most serious musculoskeletal deformities, occurring in 1-2 per 1000 newborns, 80% of clubfeet are idiopathic while 20% present with associated malformations. The etiopathogenesis of clubfoot is described as multifactorial, including both genetic and environmental risk factors. The aim of this study was to analyze possible genetic causes of isolated and syndromic clubfoot in Serbian children, as well as to correlate clinical and genetic characteristics that would provide insight into clubfoot etiopathogenesis and possibly contribute to global knowledge about clinical features of different genetically defined disorders. METHODS We evaluated 50 randomly selected, eligible children with clubfoot aged 3 to 16 years that were initially hospitalized and treated at University Children's Hospital between November 2006 and November 2022. The tested parameters were gender, age, dominant foot, affected foot, degree of deformity, treatment, neuromuscular disorders, positive family history, and maternal smoking. According to the presence of defined genetic mutation/s by whole exome sequencing (WES), patients were separated into two groups: positive (with genetic mutation/s) and negative (without genetic mutation/s). RESULTS Seven patients were found to be positive, i.e., with genetic mutation/s. A statistically significant difference between categorical variables was found for families with a history of clubfoot, where more than half (57.14%) of patients with confirmed genetic mutation/s also had a family history of genetic mutation/s (p = 0.023). CONCLUSIONS The results from this study further expand the genetic epidemiology of clubfoot. This study contributes to the establishment of genetic diagnostic strategies in pediatric patients with this condition, which can lead to more efficient genetic diagnosis.
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Affiliation(s)
- Filip Milanovic
- Pediatric Surgery Department, University Children’s Hospital, 11000 Belgrade, Serbia; (S.D.); (S.S.-A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
| | - Sinisa Ducic
- Pediatric Surgery Department, University Children’s Hospital, 11000 Belgrade, Serbia; (S.D.); (S.S.-A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
| | - Milena Jankovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Sanja Sindjic-Antunovic
- Pediatric Surgery Department, University Children’s Hospital, 11000 Belgrade, Serbia; (S.D.); (S.S.-A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
| | - Emilija Dubljanin-Raspopović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Center for Physical Medicine and Rehabilitation, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milica Aleksic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Center for Physical Medicine and Rehabilitation, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Goran Djuricic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Radiology Department, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (E.D.-R.); (M.A.); (G.D.); (D.N.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
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Pedrotti L, Bertani B, Tuvo G, Mora R, Nasi F, Manzoni F, Marin L, Moro F, De Rosa F. Ultrasonic Evaluation of the Achilles Tendon in Patients Treated for Congenital Clubfoot: Comparison between Patients Treated with Plaster Alone, Achilles Tenotomy, and Z-Plasty Lengthening. CHILDREN (BASEL, SWITZERLAND) 2024; 11:580. [PMID: 38790575 PMCID: PMC11119425 DOI: 10.3390/children11050580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Clubfoot is a common congenital deformity. The Ponseti technique, involving early corrective manipulations followed by applying long leg casts and Achilles tenotomy, is widely accepted as the preferred treatment. Rapid tendon healing after surgery has been documented, but the aspect regarding long-term tendon structure and properties is not known. Three cases of Achilles tendon rupture in adolescents previously treated for clubfoot have been described in the literature. As rupture is a rare event in this age group, a possible correlation with previous surgery has been hypothesized. The primary aim of the study was to compare the ultrasound findings of the Achilles tendon in patients treated for clubfoot, between patients treated with casting alone and with patients who underwent surgery (percutaneous tenotomy or Z-plasty lengthening). METHODS There were 22 asymptomatic patients (34 feet) with a median age of 12 years, previously treated for clubfoot, that were recruited for this study; the patients underwent an Achilles tendon ultrasound examination during a follow-up outpatient visit. RESULTS A greater thickness and increased number of structural alterations with the presence of hypoechoic areas of the operated tendons compared with those treated with plaster alone were observed (p-value: 0.0498 and <0.001, respectively). These ultrasound findings were indicative of tendon suffering, as seen in tendinopathies. CONCLUSIONS The presence of ultrasound alterations in asymptomatic patients operated on for clubfoot requires careful control of the extrinsic factors of tendinopathy in order to reduce the risk of subcutaneous rupture.
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Affiliation(s)
- Luisella Pedrotti
- Locomotor System Diseases Unit, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Barbara Bertani
- Orthopedic and Traumatology Unit, Città di Pavia Institute, 27100 Pavia, Italy; (B.B.); (G.T.); (R.M.)
| | - Gabriella Tuvo
- Orthopedic and Traumatology Unit, Città di Pavia Institute, 27100 Pavia, Italy; (B.B.); (G.T.); (R.M.)
| | - Redento Mora
- Orthopedic and Traumatology Unit, Città di Pavia Institute, 27100 Pavia, Italy; (B.B.); (G.T.); (R.M.)
| | - Fabrizio Nasi
- Outpatient Ultrasound Service, Città di Pavia Institute, 27100 Pavia, Italy;
| | - Federica Manzoni
- Epidemiology Unit, Health Protection Agency of Pavia (ATS Pavia) Italy, 27100 Pavia, Italy;
| | - Luca Marin
- Laboratory of Adapted Motor Activity, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Francesco Moro
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Federica De Rosa
- Pediatric Orthopedic and Traumatology Unit, Children’s Hospital, AON SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
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Portilla-Rojas E, Pineda-Sanabria P, Ramírez L, Cuevas MI, Lores J, Sarmiento K, Zarante I. Epidemiological characterization of clubfoot: a population-based study of a surveillance program in Colombia. J Pediatr Orthop B 2024:01202412-990000000-00198. [PMID: 38687624 DOI: 10.1097/bpb.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Clubfoot is a common musculoskeletal congenital abnormality, with a prevalence of 5-20 cases per 10 000 live births in low to middle-income countries. If left untreated, clubfoot causes severe consequences for the child: gait disturbances, reduced quality of life, and limited work opportunities. Our objective was to characterize clubfoot and determine its prevalence and associated risk factors in Bogotá and Cali, Colombia, from 2002 to 2020. A retrospective case-control study design was employed, analyzing data from birth defect reports provided by the Program for the Prevention and Follow-up of Congenital Defects and Orphan Diseases surveillance system. Cases included live births or stillbirths with clubfoot, while controls consisted of infants without congenital abnormalities, matched in terms of birth date and hospital. Prevalence was calculated considering a 95% confidence interval using Poisson distribution, and risk factors were assessed through adjusted odds ratios obtained by logistic regression model. Of 558 255 births, 861 cases of clubfoot were identified, 48.20% were postural clubfoot, and 15 cases were syndromic clubfoot. In Bogota, prevalence rate was 15.1 per 10 000 live births, whereas in Cali it was 17.29 per 10 000 live births. Family history of clubfoot within first-degree relatives was identified as a risk factor for clubfoot. Investigating risk factors for clubfoot holds significant importance in terms of preventing and reducing morbidity within this population. Helping to drive government and healthcare initiatives aimed at providing timely and effective treatment.
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Affiliation(s)
| | | | - Lina Ramírez
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá
| | | | - Juliana Lores
- Department of Basic Sciences, Faculty of Health Sciences, Pontificia Universidad Javeriana, Cali
| | | | - Ignacio Zarante
- Human Genetics Institute, Faculty of Medicine, Pontificia Universidad Javeriana
- Hospital Universitario San Ignacio, Bogotá, Colombia
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Panza R, Albano F, Casto A, Del Vecchio C, Laforgia N, Dibello D. Incidence and prevalence of congenital clubfoot in Apulia: a regional model for future prospective national studies. Ital J Pediatr 2023; 49:151. [PMID: 37964341 PMCID: PMC10648723 DOI: 10.1186/s13052-023-01559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/05/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Congenital clubfoot is a fairly common and severe congenital malformation, most often of idiopathic origin. A smaller percentage of cases is related to chromosomal abnormalities and genetic syndromes. It is estimated that 0.5/1000 newborns are affected worldwide, with a male to female ratio of 2:1 and greater distribution in developing countries (80%). The "European Surveillance of Congenital Anomalies (EUROCAT)" reported clubfoot prevalence in European newborns, but data regarding Italy are missing or poor. We aim to provide detailed data on clubfoot incidence according to the Apulian Regional Registry on Congenital Malformations and to report current knowledge on clubfoot genetic factors. METHODS We extrapolated data from the Regional Registry of Congenital Malformations to evaluate incidence and prevalence of congenital clubfoot in Apulia, Italy over a period of four years (2015-2018). We also performed a narrative review focusing on genetic mutations leading to congenital clubfoot. RESULTS Over the period from 2015 to 2018 in Apulia, Italy, 124,017 births were recorded and 209 cases of clubfoot were found, accounting for an incidence rate of 1.7/1,000 and a prevalence rate of 1.6/1,000. Six families of genes have been reported to have an etiopathogenetic role on congenital clubfoot. CONCLUSIONS Incidence and prevalence of congenital clubfoot in Apulia, Italy, are comparable with those reported in the other Italian regions but higher than those reported in previous studies from Europe. Genetic studies to better classify congenital clubfoot in either syndromic or isolated forms are desirable.
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Affiliation(s)
- Raffaella Panza
- Neonatology and Neonatal Intensive Care Unit (NICU), University of Bari Aldo Moro, Bari, Italy
| | - Federica Albano
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Alberto Casto
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Cosimo Del Vecchio
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Nicola Laforgia
- Neonatology and Neonatal Intensive Care Unit (NICU), University of Bari Aldo Moro, Bari, Italy.
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy.
| | - Daniela Dibello
- Unit of Pediatric Orthopaedics and Traumatology, Giovanni XXIII Children's Hospital, Via Giovanni Amendola, Bari, 70126, Italy
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Hedley PL, Lausten-Thomsen U, Conway KM, Hindsø K, Romitti PA, Christiansen M. Trends in congenital clubfoot prevalence and co-occurring anomalies during 1994-2021 in Denmark: a nationwide register-based study. BMC Musculoskelet Disord 2023; 24:784. [PMID: 37789312 PMCID: PMC10548612 DOI: 10.1186/s12891-023-06889-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Congenital talipes equinovarus (clubfoot) is a common musculoskeletal anomaly, with a suspected multifactorial etiopathogenesis. Herein, we used publicly available data to ascertain liveborn infants with clubfoot delivered in Denmark during 1994-2021, and to classify co-occurring congenital anomalies, estimate annual prevalence, and compare clubfoot occurrence with maternal smoking rates, a commonly reported risk factor. Characterizing this nationwide, liveborn cohort provides a population-based resource for etiopathogenic investigations and life course surveillance. METHODS This case-cohort study used data from the Danish National Patient Register and Danish Civil Registration System, accessed through the publicly available Danish Biobank Register, to identify 1,315,282 liveborn infants delivered during 1994-2021 in Denmark to Danish parents. Among these, 2,358 infants (65.1% male) were ascertained with clubfoot and classified as syndromic (co-occurring chromosomal, genetic, or teratogenic syndromes) and nonsyndromic (isolated or co-occurring multiple congenital anomalies [MCA]). Annual prevalence estimates and corresponding 95% confidence intervals (CIs) for children with nonsyndromic clubfoot were estimated using Poisson regression and compared with population-based, maternal annual smoking rates obtained from publicly available resources. RESULTS Infants most often presented with nonsyndromic clubfoot (isolated = 88.6%; MCA = 11.4%); limb and heart anomalies were the most frequently identified MCAs. Prevalence (per 1,000 liveborn infants) was 1.52 (CI 1.45-1.58) for isolated and 0.19 (CI 0.17-0.22) for MCA clubfoot. Prevalence estimates for both isolated and MCA clubfoot remained relatively stable during the study period, despite marked decreases in population-based maternal smoking rates. CONCLUSIONS From 1994 to 2021, prevalence of nonsyndromic clubfoot in Denmark was relatively stable. Reduction in population-level maternal smoking rates did not seem to impact prevalence estimates, providing some support for the suspected multifactorial etiopathogenesis of this anomaly. This nationwide, liveborn cohort, ascertained and clinically characterized using publicly available data from the Danish Biobank Register, provides a population-based clinical and biological resource for future etiopathogenic investigations and life course surveillance.
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Affiliation(s)
- Paula L Hedley
- Department for Congenital Disorders, Statens Serum Institut, 5 Artillerivej DK2300S, Copenhagen, Denmark.
| | | | - Kristin M Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Klaus Hindsø
- Pediatric Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Paul A Romitti
- Department for Congenital Disorders, Statens Serum Institut, 5 Artillerivej DK2300S, Copenhagen, Denmark
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Michael Christiansen
- Department for Congenital Disorders, Statens Serum Institut, 5 Artillerivej DK2300S, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Smythe T, Rotenberg S, Lavy C. The global birth prevalence of clubfoot: a systematic review and meta-analysis. EClinicalMedicine 2023; 63:102178. [PMID: 37680947 PMCID: PMC10480528 DOI: 10.1016/j.eclinm.2023.102178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 09/09/2023] Open
Abstract
Background Estimates of the birth prevalence of clubfoot in low and middle income settings range from 0.5 to 2 per 1000 births. However, there is currently no estimate of global birth prevalence of clubfoot. Methods We conducted a systematic review of studies reporting the birth prevalence of clubfoot across all countries and regions worldwide in the last 10 years. Africa Wide Information, EMBASE, CINAHL, Global Health, LILACS and Medline databases were searched for relevant studies from January 1st 2012 to February 9th 2023. Pooled prevalence estimates were calculated using the inverse variance method, and a random effects model was applied to account for heterogeneity between studies. Quality appraisal was performed using a modified Newcastle-Ottawa Quality Assessment Scale for Cohort studies. This review was registered with PROSPERO, CRD42023398410. Findings The search generated 757 studies. Thirty-five studies from 36 countries and five WHO regions were included. The pooled prevalence of clubfoot was 1.18 per 1000 births (95% CI: 1.00-1.36) based on data from 44,818,965 births. The highest prevalence rates were observed in low- and middle-income countries, particularly in the South-East Asia Region (1.80, 95% CI: 1.32-2.28) and the Africa Region (1.31, 95% CI: 0.86-1.77). We estimate that 176,476 (95% CI: 126,126-227,010) children will be born with clubfoot globally each year. Interpretation This study provides a comprehensive estimate of the global prevalence of clubfoot and highlights the significant burden of this condition, particularly in low- and middle-income countries. The findings underscore the need for improving access to effective treatment and prevention strategies in resource-limited settings. Funding SR received funds from the Global Clubfoot Initiative and the Rhodes Trust.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, WC1E 7HT, UK
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Sara Rotenberg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Reumatology and Musculoskeletal Sciences University of Oxford, OX2 6GG, UK
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Johansson GA, Aurell YB, Romanus BH. A four-year clinical and sonographic longitudinal follow-up of clubfeet treated according to Ponseti with normal references. J Child Orthop 2023; 17:212-223. [PMID: 37288050 PMCID: PMC10242368 DOI: 10.1177/18632521231172548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 04/09/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose To follow children with a clubfoot by ultrasonography during the entire treatment period up to 4 years and compare with controls. Method Thirty clubfeet in 20 children treated using the Ponseti method and 29 controls were followed by repeated ultrasonography investigations from neonates to the age of 4 years. The previously established coronal medial and lateral, sagittal dorsal and posterior projections were used. Changes over time, correlations to the Diméglio score, and the course of treatment were studied. Results The medial malleolus-navicular distance was shorter, while the talar tangent-navicular distance and the talo-navicular angle were larger in clubfeet than in controls even after the initial correction. The healthy feet in unilateral cases did not differ significantly from the controls. The range of motion in the talo-navicular joint was approximately 20° less in clubfeet than in controls during the first four years of life. The medial malleolus-navicular distance (r = -0.58) and the talo-navicular angle (r = 0.66) at the first ultrasonography showed the highest correlation to the number of casts needed to correct the deformities. Conclusion Ultrasonography can be used to evaluate the initial degree of deformities in clubfeet and to follow the progress of the treatment and growth. Ultrasonography showed a clear difference between clubfeet and controls during the first four years of life. Although it was not possible to define specific limit values as benchmarks in the treatment, dynamic ultrasonography can provide valuable support in the decision-making process when complementary treatment may be needed. Level of evidence III.
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Affiliation(s)
- G Arne Johansson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Region Västra Götaland, Skaraborg Hospital, Skövde, Sweden
| | - Ylva B Aurell
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Diagnostic Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil H Romanus
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Grin L, van Oorschot L, Vanwanseele B, Wijnands SDN, Kars HJJC, Besselaar AT, van der Steen MCM. Kinematic Gait Impairments in Children with Clubfeet Treated by the Ponseti Method: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050785. [PMID: 37238333 DOI: 10.3390/children10050785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Being aware of possible gait impairments in Ponseti-treated clubfoot children might be useful for optimizing initial and additional treatment. Therefore, this systematic review and meta-analysis aimed to identify kinematic gait abnormalities in children with clubfoot treated with the Ponseti method (with and without relapse). METHODS A systematic search was conducted. Studies comparing kinematic gait parameters of Ponseti-treated clubfoot children to healthy controls were included. Meta-analyses and qualitative analyses were conducted on the extracted data. RESULTS Twenty studies were identified. Twelve of the 153 reported kinematic outcome measures could be included in the meta-analysis. Plantarflexion at push-off, maximum ankle dorsiflexion during the swing, maximal plantarflexion, and ankle range of motion was significantly lower in Ponseti-treated clubfoot children. Ponseti-treated clubfoot children showed more internal foot progression. Qualitative analysis revealed 51 parameters in which pre-treatment relapse clubfeet deviated from healthy controls. CONCLUSIONS Ponseti-treated clubfoot children showed several kinematic gait differences from healthy controls. In future studies, homogeneity in measured variables and study population and implementation of multi-segmental foot models will aid in comparing studies and understanding clubfoot complexity and treatment outcomes. The question remains as to what functional problems gait impairments lead to and whether additional treatment could address these problems.
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Affiliation(s)
- Lianne Grin
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
| | - Lisa van Oorschot
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
| | - Benedicte Vanwanseele
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
| | - Saskia D N Wijnands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
| | - H J J Cojanne Kars
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
| | - Arnold T Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
| | - M C Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, 5602 ZA Eindhoven, The Netherlands
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Mustari MN, Faruk M, Bausat A, Fikry A. Congenital talipes equinovarus: A literature review. Ann Med Surg (Lond) 2022; 81:104394. [PMID: 36147065 PMCID: PMC9486628 DOI: 10.1016/j.amsu.2022.104394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022] Open
Abstract
Congenital talipes equinovarus (CTEV) is a congenital disability characterized by leg deformities in the cavus, adducts, varus, and equinus. The etiology of CTEV is poorly understood, despite its incidence ranging from 0.76 to 3.49 cases per 1000 live births in Indonesia. CTEV involves the fixation of the foot in the adducts, varus, and equinus with concurrent soft tissue anomalies. Despite advances in treatment, disability often persists. Theoretical models have been proposed for neurological, vascular, connective tissue, bone, and muscular causes; however, the currently available data suggests that mild cases are associated with intrauterine position. CTEV's etiology appears to involve a hereditary component, as its prevalence varies by ethnic group. Genetic factors have been identified in 24–50% of cases, depending on the community studied. Based on a complex segregation analysis, the most plausible inheritance pattern is a single large-effect gene interacting with a polygenic background. CTEV is a congenital disability characterized by leg deformities in the cavus, adducts, varus, and equinus. In Indonesia, its incidence ranges from 0.76 to 3.49 cases per 1000 live births. Genetic factors have been identified in 24–50% of cases, depending on the community studied.
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