Clubfoot and its implications for the locomotion of a medieval skeleton from Estremoz, Portugal

OBJECTIVE

This study describes foot bone anomalies and the degenerative changes associated with locomotion adaptations.

MATERIALS

An adult male (approximately 29-46 years old) from Estremoz, Portugal (13th-15th century).

METHODS

The skeletal anomalies observed in this skeleton were described and measurements were compared between both sides of the individual and with the mean of the adult males from the same collection.

RESULTS

The most anomalous bones are the right medial cuneiform and metatarsals. Degenerative changes are more severe on the left lower limb and right upper limb.

CONCLUSIONS

This skeleton represents a unilateral case of talipes varus of the right foot, with the metatarsals being more affected while previously published cases show more severe anomalies of the hindfoot. The degenerative changes observed in the skeleton suggest that both legs and arms, aided by crutches, were used for locomotion.

SIGNIFICANCE

This case shows that club foot skeletal anomalies are variable and the pattern of bony changes throughout the body can reveal locomotion adaptations.

LIMITATIONS

The possibility of a genetic cause cannot be assessed due to the absence of paleogenomic data.

SUGGESTIONS FOR FURTHER RESEARCH

Since the anomalies found in this case are different than those previously published, we recommend care when analysing foot bones.

Novel report on congenital talipes equinovarus (CTEV) following olanzapine exposure during pregnancy: case report and short review

Olanzapine is widely used during pregnancy to manage mood and psychotic disorders with overall beneficial effects. There have been past reports of olanzapine exposure during early pregnancy and clubfoot in two newborns from India and Israel. We report a woman in Nepal diagnosed with schizophrenia and treated with olanzapine throughout the pregnancy delivering a baby boy with congenital talipes equinovarus deformity. Like in many other low-income settings, pregnancy was unplanned, and pre-conception counselling was not done. Research in mice has revealed the negative effects of olanzapine on bone development. Further reports would strengthen this potential association between exposure to olanzapine in the first trimester and the occurrence of clubfoot in the baby.