Clubfoot and Rocker-Bottom Foot





KEY FACTS


Terminology





  • Clubfoot (talipes equinovarus)




    • Foot is turned in at ankle (varus)



    • Foot is pointed (equina)




  • Rocker-bottom foot (congenital vertical talus)




    • Back of foot is convex (like bottom of rocking chair)



    • Toes are upturned




Imaging





  • Clubfoot: 2/3 bilateral




    • Frontal tibia/fibula view best to show turned-in foot



    • Plantar foot view shows short angulated foot



    • 2/3 are isolated: No other anomalies



    • Key associations: Spina bifida, arthrogryposis, aneuploidy, oligohydramnios




  • Rocker-bottom foot: 2/3 bilateral




    • Sagittal view best to show morphology



    • Rarely isolated



    • Key associations: Aneuploidy (particularly trisomy 18), spine anomalies, arthrogryposis




Clinical Issues





  • Clubfoot is most common musculoskeletal anomaly




    • 1-3:1,000 newborns



    • Prognosis depends on associated anomalies



    • Most do not need surgical correction




  • Rocker-bottom foot requires more significant intervention



Scanning Tips





  • 3D helps show severity




    • Bone-rendered views are additive




  • Beware of transient foot position




    • Wait for feet to move away from uterus



    • Avoid 3rd-trimester diagnosis if possible




      • Higher false-positive rates





  • Look carefully at spine, upper extremities, and fetal movement when lower extremity anomaly diagnosed







In this case of isolated unilateral clubfoot at 24 weeks, 3D ultrasound shows a right inverted clubfoot and a normal left foot . 3D images allow for better appreciation of the severity of the clubfoot and allows the patient and orthopedic team to truly see the anomaly.








Frontal shin views in a 20-week fetus shows both feet turned inward , classic varus deformity of clubfoot. The finding was isolated and genetic testing was not done. Bilateral isolated clubfoot does not increase risk of aneuploidy over unilateral.








Graphic shows a vertical talus , which pushes the heel posteriorly and bows the sole, creating a rocker-bottom appearance. The correlative ultrasound shows the rocker-bottom heel and upturned toes .

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Nov 10, 2024 | Posted by in ULTRASONOGRAPHY | Comments Off on Clubfoot and Rocker-Bottom Foot

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