Does familial clubfoot have worse course and outcomes than non-familial clubfoot?

Isolated (non-syndromic) Clubfoot has some familial tendency. Clubfoot has an unknown etiology and an unclear relationship to certain genes. On top of an increased rate of familial occurrence, it has been suspected that familial (isolated) clubfoot demands longer treatments while delivering less favorable outcomes. Thus, we sought to evaluate if familial clubfoot has the same features and reacts to the standard (i.e. Ponseti) treatment. In this study, data regarding the clinical course of treatment for 24 babies with familial clubfoot was compared to that of 65 babies with non-familial clubfoot. The babies were grouped so each familial case was paired with 2-3 non-familial control patients with the same sex and birth year. Certain features were more common in familial cases, including bilateral clubfeet (66% vs. 39%) and atypical features (27% vs. 6%). The mean number of casts needed for correction was slightly higher (7.2 vs. 5.9) in familial cases, and an indication for Achilles tenotomy was higher (100% vs. 82%) as well. Further evaluation revealed a higher need for re-tenotomy (47% vs. 6%), and for additional treatments (53% vs. 9%) in familial clubfoot. The differences in treatment, although statistically significant, do not represent a major deviation from the standard Ponseti protocol. Nevertheless, they may show a substantial difference between the way we treat each group. Familial clubfoot probably represents a more severe type of clubfoot. Although a genetic cause of clubfoot has not been elucidated, these findings support the assumption that an inherited characteristic is involved in the etiology of clubfoot and may in fact offer a worse prognosis.