Reliability of Clinical Features in Identifying Atypical Club Foot

Atypical clubfeet, which is often refractory to the classical Ponseti manipulations have special clinical features. It is important to identify these atypical club feet from these clinical features, so as to modify the manipulation technique, for optimal results. In this study, we assessed the presence of the different clinical features in diagnosing atypical clubfeet and its influence on subsequent management protocol, using modified Ponseti technique.

Fifty two atypical club feet with a mean age of 3.3 months were assessed for the presence of different clinical features and subsequently treated by modified Ponseti casting. Mean of the number of casts required to correct the deformity were correlated with the various clinical features present.

Short hyperextended great toe, which was smaller than the 2nd toe was the most consistent finding seen in all of the cases. This was followed by the presence of deep plantar crease (plantaris) and short swollen chubby foot as seen in more than 90 per cent of cases. Deep posterior crease; tight, wide and long heel cord; rigid equinus and history of slippage of casts were observed in 35 (67.3%), 25 (48.07%), 33 (63.4%) and 12 (23%) cases, respectively. Presences of all the seven clinical features were seen only in 12 (23%) feet. Mean number of casts required to correct the deformity were 8.8 (range 7 to 12). When atypical club foot was associated with presence of any other additional clinical feature, mean casts required to correct deformity was 9.4. When two or more additional clinical features were present mean number of casts required was 9.9.

In this study, short hyperextended great toe, great toe smaller than 2nd toe, short swollen chubby foot and deep plantar crease (plantaris) with severe plantar flexion of all metatarsals were the most reliable clinical features of atypical clubfeet. We noted that the mean number of casts required to correct atypical club foot was higher when compared with idiopathic clubfoot correction, as reported in literature. Furthermore, the number of casts required for correction, increases with the presence of each additional clinical feature(s), i.e., more the clinical features out of seven, noted above, more casts required for correction.

The online version contains supplementary material available at 10.1007/s43465-026-01824-z.