Does laterality of deformity influence the severity of the idiopathic clubfoot?

Abstract

Background: The idiopathic clubfoot has been widely reported as the commonest congenital deformity of the lower limbs with incidence of approximately 1-2 in 1000 live births. Its exact aetiology is not known. The deformity is bilateral in more than half of the cases. This study was designed to compare the severity of bilateral and unilateral idiopathic clubfoot, and to determine if there is any correlation between the left and right feet of bilateral cases.

Methods: Records of all patients with idiopathic clubfoot who presented at our clubfoot clinic between January 2013 and November 2018 were reviewed. Patients were categorized into two groups, the 'Bilateral Idiopathic Clubfoot' and 'Unilateral Idiopathic Clubfoot' groups. The degree of deformity of each affected foot was categorized based on the Pirani score at presentation as 'Less Severe' for scores less than or equal to 4.0. Statistical analysis and tests for associations and correlation between variables were done using IBM SPSS version 22.0.

Result: Records of 185 idiopathic clubfoot cases belonging to 120 (65 bilateral, 55 unilateral) patients who met the inclusion criteria were studied. The age range of the patients at presentation was 3 days to 24 months. The degree of deformity was proportionately more severe in the 'Bilateral Idiopathic Clubfoot' group compared to the 'Unilateral Idiopathic Clubfoot' group (p<0.0001). The left and right feet of the bilateral cases were highly correlated (r=0.861, p<0.0001).

Conclusion: Bilateral idiopathic clubfoot cases were more severely deformed than unilateral idiopathic clubfoot cases. Left and right feet of bilateral cases were highly correlated.

Keywords: Severity, bilateral, idiopathic, clubfoot, correlation