Knee Bend Test for a Preclinical Clubfoot Deformity (See Case 3)

X-Rays Changes - Normal Foot vs Preclinical Clubfoot Deformity

Photos - Embryological Foot Types

X-Rays  - Clinical vs PreClinical Clubfoot Deformity

X-Rays - Clinical vs PreClinical Clubfoot Deformity (Animated)


 

PreClinical Clubfoot Deformity in an Infant

The Preclinical Clubfoot Deformity (Calcaneal Talar Supinatus)

Etiology:  torsional development of the foot ends before the 9th week post-ovulation, calcaneus and talus remain in supinatus (See Figure 1).


Figure 1 - Preclinical Clubfoot Deformity (PCFD): Calcaneal - Talar Supinatus


Clinical Findings: microwedge measurements between 30 and 60 millimeters.  Weight bearing, knees extended, the feet are pronated (See Figures 2a & 2b). (PMs values above 60 millimeters are linked to the Clubfoot Deformity.)  Lateral (Side) View of the Preclinical Clubfoot Deformity.

Figure 2a


Figure 2b -  Weight bearing, Knees Extended


Differential Diagnosis: Preclinical Clubfoot Deformity vs

(1) Primus Metatarsus Supinatus (See Foot Types)

Preclinical Clubfoot Deformity (PCFD) vs Primus Metatarsus Supinatus foot type (PMs):  weight bearing, knees extended, the PCFD foot is pronated, the PMs is not pronated.  The Knee Bend Test facilitates the differential diagnosis between these two embryological foot types.

  • Measuring the Preclinical Clubfoot Deformity (Higher PMs Values).  Treadmill Analysis of the Preclinical Clubfoot Deformity: barefooted; shodded with vs without Proprioceptive Signal 
  • Measuring the Primus Metatarsus Supinatus foot type (Lower PMs Values). Treadmill Analysis Primus Metatarsus Supinatus foot type (Photo Analysis Primus Metatarsus Supinatus foot type)

(2) Tarsal Coalition

(3) Spring Ligament Laxity (Ehlers-Danlos Syndrome and Marfan Syndrome)

Treatment (Preclinical Clubfoot Deformity):  rearfoot and forefoot proprioceptive stimulators (severely functional flatfeet may require the use of arch supports in conjunction with the stimulators)

In severe cases, where the structural integrity of the talonavicular joint is irreparably damaged, the use of supportive type orthoses may be required.