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Incidence of congenital clubfoot in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2006 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 77, no 6, 847-852 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Idiopathic clubfoot is one of the most common congenital orthopedic problems. Nationwide studies of the incidence are scarce. We performed a prospective multicenter study in order to assess the cumulative incidence in Sweden over 2 consecutive years. PATIENTS AND METHODS: 44 clinics identified as treating clubfoot reported new cases prospectively. The medical records of 280 children with clubfoot born during 1995- 1996 were collected and analyzed with special reference to gender, regional distribution and seasonal variation. RESULTS: The average cumulative incidence of clubfoot during the study period was 1.4/10(3) (95% CI 1.2- 1.6). Three-quarters of the cases were boys. In half of the cases both feet were affected. There was significant regional heterogeneity, but no seasonal variation in occurrence of clubfoot. INTERPRETATION: The cumulative incidence was higher than in earlier Scandinavian studies. Gender distribution and laterality were similar to those in previous reports. We found significant regional differences in incidence, but the cause of this observation must be investigated in greater depth.

Place, publisher, year, edition, pages
2006. Vol. 77, no 6, 847-852 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-25103DOI: 10.1080/17453670610013123ISI: 000243586300003PubMedID: 17260191OAI: oai:DiVA.org:uu-25103DiVA: diva2:52877
Available from: 2007-03-03 Created: 2007-03-03 Last updated: 2011-02-16Bibliographically approved
In thesis
1. Congenital clubfoot: Aspects on epidemiology, residual deformity and patient reported outcome
Open this publication in new window or tab >>Congenital clubfoot: Aspects on epidemiology, residual deformity and patient reported outcome
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis on congenital clubfoot was to estimate the incidence with a national perspective, analyse residual deformities and their management, and evaluate patient reported long-term quality of life and foot function.

Paper I was a prospective, nationwide sampling of 280 children with congenital clubfoot during 1995-96. The average incidence was 1.4‰. There was regional heterogeneity but no seasonal variation.

Paper II evaluated ultrasonography on 54 newborn, prospectively followed up to 12 months of age. Significant increase of medial malleolus to navicular distance (MM-N-distance) and of soft tissue thickness with increasing age was seen and with acceptable reliability.

Paper III assessed 35 children (47 feet) after previous posterior release, mean age of 4.5 years, and the MM-N-distance was shorter in unilateral clubfeet (21 patients) than in contralateral normal feet. No association between navicular position and forefoot adduction (FFA) was determined. Smaller FFA yielded better subjective and functional outcome.

Paper IV reviewed distraction treatment with Ilizarov External Fixator in seven patients (10 feet), 6-15 years of age, with relapsed deformities. All patients, except one, reported satisfaction with the overall result but less stiffness was experienced in only 4/10 feet.

Paper V evaluated self-estimated outcome in 83 patients (63 males, 20 females), mean age of 64 years, through SF-36 and EQ-5D, and through AAOS foot and ankle score. Age and gender adjusted norm groups were used. Female patients scored worse than male patients did. Both males and females reported negative influence on foot and ankle function.

Conclusion: The incidence of congenital clubfoot in Sweden is higher than in previous Scandinavian studies. Ultrasonography is reliable for describing pathoanatomy of the talo-navicular joint in clubfeet and can detect "spurious" (false) correction. Distraction treatment with the Ilizarov External Fixator yields subjective improvement but stiffness remains. Long-term influence on daily life activities is limited to foot and ankle function for both genders, but only female patients report negative influence on physical aspects of quality of life.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 48 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 464
Congenital clubfoot, incidence, ultrasonography, forefoot adduction, navicular position, spurious correction, Ilizarov External Fixator, subjective outcome, stiffness, patient reported outcome, norm group, gender difference
National Category
Research subject
urn:nbn:se:uu:diva-106366 (URN)978-91-554-7563-5 (ISBN)
Public defence
2009-10-03, Brömssalen, Gävle Sjukhus, Gävle, 13:00 (English)
Available from: 2009-09-11 Created: 2009-06-22 Last updated: 2009-09-11Bibliographically approved

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