Club foot
Encyclopedia
A club foot, or congenital talipes equinovarus (CTEV), is a congenital deformity involving one foot or both. The affected foot appears rotated internally at the ankle. TEV is classified into 2 groups: Postural TEV or Structural TEV.
Without treatment, persons afflicted often appear to walk on their ankles, or on the sides of their feet. It is a common birth defect, occurring in about one in every 1,000 live births. Approximately 50% of cases of clubfoot are bilateral. In most cases it is an isolated dysmelia
. This occurs in males more often than in females by a ratio of 2:1. A condition of the same name appears in animals, particularly horse
s.
The deformities can be remembered using the mnemonic
, "InAdEquate" for Inversion, Adduction and Equinus.
factors such as Edwards syndrome
, a genetic defect with three copies of chromosome 18. Growth arrests at roughly 9 weeks and compartment syndrome
of the affected limb are also causes of Structural cTEV. Genetic influences increase dramatically with family history. It was previously assumed that postural cTEV could be caused by external influences in the final trimester such as intrauterine compression from oligohydramnios
or from amniotic band syndrome
. However, this is countered by findings that cTEV does not occur more frequently than usual when the intrauterine space is restricted. Breech presentation
is also another known cause.
cTEV occurs with some frequency in Ehlers Danlos Syndrome and some other connective tissue disorders, such as Loeys-Dietz Syndrome
. TEV may be associated with other birth defects such as spina bifida
cystica.
, physiotherapists, orthopedic surgeons, specialist Ponseti nurses
, or orthotists by providing braces to hold the feet in orthodox positions, serial casting, or splints called knee ankle foot orthoses (KAFO). Other orthotic options include Dennis-Brown bars with straight last boots, ankle foot orthoses and/or custom foot orthoses (CFO). In North America, manipulation is followed by serial casting, most often by the Ponseti Method
. Foot manipulations usually begin within two weeks of birth. Even with successful treatment, when only one side is affected, that foot may be smaller than the other, and often that calf, as well.
Extensive surgery of the soft tissue or bone is not usually necessary to treat clubfoot; however, there are two minimal surgeries that may be required:
Of course, each case is different, but in most cases extensive surgery is not needed to treat clubfoot. Extensive surgery may lead to scar tissue developing inside the child's foot. The scarring may result in functional, growth and aesthetic problems in the foot because the scarred tissue will interfere with the normal development of the appendage. A child who has extensive surgery may require on average two additional surgeries to correct the issues presented above.
In stretching and casting therapy the doctor changes the cast multiple times over a few weeks, gradually stretching tendons until the foot is in the correct position of external rotation. The heel cord is released (percutaneous tenotomy) and another cast is put on, which is removed after three weeks. To avoid relapse a corrective brace is worn for a gradually reducing time until it is only at night up to four years of age.
. Foot manipulations differ subtly from the Kite casting method which prevailed during the late 20th century. Although described by Dr. Ignacio Ponseti
in the 1950s, it did not reach a wider audience until it was re-popularized around 2000 by Dr. John Herzenberg in the USA and in Europe and Africa by NHS
surgeon Steve Mannion while working in Africa. Parents of children with clubfeet using the Internet also helped the Ponseti gain wider attention. The Ponseti method, if correctly done, is successful in >95% of cases in correcting clubfeet using non- or minimal-surgical techniques. Typical clubfoot cases usually require 5 casts over 4 weeks. Atypical clubfeet and complex clubfeet may require a larger number of casts. Approximately 80% of infants require an Achilles tenotomy (microscopic incision in the tendon requiring only local anesthetic and no stitches) performed in a clinic toward the end of the serial casting.
Throughout the past decade, physicians at Texas Scottish Rite Hospital for Children
have been studying the effectiveness of both the Ponseti casting method and the French functional (physical therapy) method of stretching, massaging and taping and comparing the results with patients who have undergone surgery. Results of these studies have been presented at national and international conferences, such as the Pediatric Orthopaedic Society of North America annual meeting, the International Clubfoot Symposium, Brandon Carrell Visiting Professorship and the American Academy of Orthopaedic Surgeons annual meeting, and have been published in the Journal of Pediatric Orthopaedics.
After correction has been achieved, maintenance of correction may require the full-time (23 hours per day) use of a splint—also known as a foot abduction brace (FAB)—on both feet, regardless of whether the TEV is on one side or both, for several weeks after treatment. Part-time use of a brace (generally at night, usually 12 hours per day) is frequently prescribed for up to 4 years. Without the parents' participation, the clubfoot will almost certainly recur, because the muscles around the foot can pull it back into the abnormal position. Approximately 20% of infants successfully treated with the Ponseti casting method may require a surgical tendon transfer after two years of age. While this requires a general anesthetic, it is a relatively minor surgery that corrects a persistent muscle imbalance while avoiding disturbance to the joints of the foot.
The developer of the Ponseti Method, Dr Ignacio Ponseti, was still treating children with clubfeet (including complex/atypical clubfeet and failed treatment clubfeet) at the University of Iowa Hospitals and Clinics well into his 90s. He was assisted by Dr Jose Morcuende, president of the Ponseti International Association.
The long-term outlook for children who experienced the Ponseti Method treatment is comparable to that of non-affected children.
Watch a Video on the Ponseti Method
Botox is also being used as an alternative to surgery. Botox is the trade name for Botulinum Toxin type A. a chemical that acts on the nerves that control the muscle. It causes some paralysis(weakening) of the muscle by preventing muscle contractions (tightening). As part of the treatment for clubfoot, Botox is injected into the child’s calf muscle. In about 1 week the Botox weakens the Achilles tendon. This allows the foot to be turned into a normal position, over a period of 4–6 weeks, without surgery.
The weakness from a Botox injection usually lasts from 3–6 months. (Unlike surgery it has no lasting effect). Most club feet can be corrected with just one Botox injection. It is possible to do another if it is needed. There is no scar or lasting damage.
BC Women and Childrens Hospital
Without any treatment, a child's clubfoot will result in severe functional disability, however with treatment, the child should have a nearly normal foot. He or she can run and play without pain and wear normal shoes. The corrected clubfoot will still not be perfect, however; a clubfoot usually stays 1 to 1½ sizes smaller and somewhat less mobile than a normal foot. The calf muscles in a leg with a clubfoot will also stay smaller.
Long-term studies of adults with post-club feet, especially those with substantial numbers of surgeries, may not fair as well in the long term, according to Dobbs, et. al., A percentage of adults may require additional surgeries as they age, though there is some dispute as to the effectiveness of such surgeries, in light of the prevalence of scar tissue present from earlier surgeries.
Many notable people have been born with one or both feet in "clubbed" condition, including Roman emperor Claudius
, Egyptian pharaoh Tutankhamun
, statesman Prince Talleyrand, Civil War politician Thaddeus Stevens
, comedian Damon Wayans
, actor Gary Burghoff, and Eric The Midget
from The Howard Stern Show, football players Steven Gerrard
and Miguel Riffo
, sledge hockey player Matt Lloyd
, a Paralympian, mathematician Ben Greenberg, and filmmaker Jennifer Lynch
.
The British Romantic poet George Gordon, Lord Byron had a clubfoot, which caused him much humiliation.
Comedian, musician, and actor Dudley Moore
was born with a club foot. This was mostly unknown to the public as he wore one shoe with a slightly bigger sole to compensate when walking.
The figure-skater Kristi Yamaguchi
was born with a clubfoot, and went on to win gold medals at both the Olympics and World Championships. The soccer star Mia Hamm
was born with the condition. Baseball pitcher Larry Sherry
, the 1959 World Series MVP, was born with club feet, as was pitcher Jim Mecir
, and both enjoyed long and successful careers. In fact, it was suggested in the book Moneyball that Mecir's club foot contributed to his success on the mound; it caused him to adopt a strange delivery that "put an especially violent spin" on his screwball
, his specialty pitch. The San Francisco Giants
held the record as the team with the all-time highest number of players with clubbed feet as of July 2010, and Freddy Sanchez
, one of its infielders, cites his ability to overcome the defect as a reason for his success. Tom Dempsey
of the New Orleans Saints
, born with a right club foot and no toes (this was his kicking foot), kicked an NFL record 63 yards (57.6 m) field goal. This kick became famous as the longest NFL field goal in history. Former NFL quarterback Troy Aikman
beat being born with a clubfoot to enjoy a productive Hall of Fame
career.
The Nazi
Propaganda Minister
Joseph Goebbels
had a right clubfoot (possibly incurred after birth as a complication of osteomyelitis
), a fact hidden from the German public by censorship. Because of this malformation, Goebbels needed to wear a leg brace. That, plus his short stature, led to his rejection for military service in World War I
.
De Witt Clinton Fort
, who served in the Confederate Army as a captain, was born with a clubfoot, and he was known during the American Civil War as Captain "Clubfoot" Fort, C.S.A.
Tutankhamun
had a club foot and a cleft palate, and it is likely that he needed a cane to walk.
Princess Isabella of Denmark was born with a clubfoot as shown in this photograph at one year old and in this photograph at three years old.
Club feet occur in other animals, notably equines
. The condition is characterized by a strongly upright pastern
and a corresponding rotation of the coffin bone in the hoof
. The condition often affects only one foot. Severity varies, with some animals usable for work or riding, and others unsound for life. Careful farrier
work on the hooves can lessen the severity of many cases, and in certain circumstances surgery may be beneficial. The visible outward appearance of a club foot has different possible origins that include a genetic predisposition to the condition, a congenital defect formed while the animal is in the womb, or problems with diet and bone development during the early post-natal period. Certain horse breeds appear to be more predisposed to the condition than others, but research has yet to identify the genes involved.
A grading scale exists to assess the severity of club feet, which are caused by a deep digital flexor contraction syndrome. When the muscle fibers of the upper leg's deep ditigal flexor muscle contract excessively, this affects the tendon of the same name that comes off of this muscle group and attaches at the bottom of the coffin bone. A constant upward pull by the tendon on the coffin bone and other structure of the horse's hoof creates the condition. While many young foal
s are born with somewhat upright pasterns, the condition may resolve naturally or with minimal intervention if begun early. However, some cases are so severe that more drastic treatment may be required.
Without treatment, persons afflicted often appear to walk on their ankles, or on the sides of their feet. It is a common birth defect, occurring in about one in every 1,000 live births. Approximately 50% of cases of clubfoot are bilateral. In most cases it is an isolated dysmelia
Dysmelia
Dysmelia is a congenital disorder referring to the limbs. -Types:Dysmelia can refer to*missing limbs: amelia, oligodactyly, congenital amputation...
. This occurs in males more often than in females by a ratio of 2:1. A condition of the same name appears in animals, particularly horse
Horse
The horse is one of two extant subspecies of Equus ferus, or the wild horse. It is a single-hooved mammal belonging to the taxonomic family Equidae. The horse has evolved over the past 45 to 55 million years from a small multi-toed creature into the large, single-toed animal of today...
s.
Deformities
The deformities affecting joints of the foot occur at three joints of the foot to varying degrees. They are- Inversion at subtalar jointSubtalar jointIn human anatomy, the subtalar joint, also known as thetalocalcaneal joint, is a joint of the foot. It occurs at the meeting point of the talus and the calcaneus.-Motion:...
- AdductionAdductionAdduction is a movement which brings a part of the anatomy closer to the middle sagittal plane of the body. It is opposed to abduction.-Upper limb:* of arm at shoulder ** Subscapularis** Teres major** Pectoralis major** Infraspinatus...
at talonavicular joint and - equinus at ankle joint, that is, a plantarflexed position, making the foot tend towards toe walkingToe walkingToe walking refers to a condition where a person walks on his or her toes without putting much weight on the heel or any other part of the foot. Toe-walking in toddlers is common. These children usually adopt a normal walking pattern as they grow older...
.
The deformities can be remembered using the mnemonic
Mnemonic
A mnemonic , or mnemonic device, is any learning technique that aids memory. To improve long term memory, mnemonic systems are used to make memorization easier. Commonly encountered mnemonics are often verbal, such as a very short poem or a special word used to help a person remember something,...
, "InAdEquate" for Inversion, Adduction and Equinus.
Causes
There are different causes for clubfoot depending on what classification it is given. Structural cTEV is caused by geneticGenetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
factors such as Edwards syndrome
Edwards syndrome
Trisomy 18 is a genetic disorder caused by the presence of all or part of an extra 18th chromosome. It is named after John H. Edwards, who first described the syndrome in 1960...
, a genetic defect with three copies of chromosome 18. Growth arrests at roughly 9 weeks and compartment syndrome
Compartment syndrome
Compartment syndrome is a limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space within the body . This leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure...
of the affected limb are also causes of Structural cTEV. Genetic influences increase dramatically with family history. It was previously assumed that postural cTEV could be caused by external influences in the final trimester such as intrauterine compression from oligohydramnios
Oligohydramnios
Oligohydramnios is a condition in pregnancy characterized by a deficiency of amniotic fluid. It is the opposite of polyhydramnios.-Diagnosis:Diagnosis is made by ultrasound measurement of the amniotic fluid index...
or from amniotic band syndrome
Amniotic band syndrome
Amniotic band syndrome is a congenital disorder caused by entrapment of fetal parts in fibrous amniotic bands while in utero.-Epidemiology:Amniotic banding affects approximately 1 in 1,200 live births...
. However, this is countered by findings that cTEV does not occur more frequently than usual when the intrauterine space is restricted. Breech presentation
Breech birth
A breech birth is the birth of a baby from a breech presentation. In the breech presentation the baby enters the birth canal with the buttocks or feet first as opposed to the normal head first presentation....
is also another known cause.
cTEV occurs with some frequency in Ehlers Danlos Syndrome and some other connective tissue disorders, such as Loeys-Dietz Syndrome
Loeys-Dietz syndrome
Loeys-Dietz syndrome is a recently-discovered autosomal dominant genetic syndrome which has many features similar to Marfan syndrome, but which is caused by mutations in the genes encoding transforming growth factor beta receptor 1 or 2 .It was identified and characterized by American physician...
. TEV may be associated with other birth defects such as spina bifida
Spina bifida
Spina bifida is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through...
cystica.
Prenatal Screening
Screening for club foot prenatally is a debatable topic. However, this is commonly done as it is easily identified using a ultrasound scan. Most fetuses undergo a 20 weeks gestation fetal abnormality scan in which club foot is one of the abnormalities that can be picked up. Some doctors have argued that club foot may occasionally be associated with a syndromic disease and should therefore be screened. If no syndromic association is found prenatally, most fetuses with club foot are born and can live a normal life with medical treatment.Treatment
Clubfoot is treated with manipulation by podiatristsPodiatry
Podiatry is a branch of medicine devoted to the study, diagnosis, and treatment of disorders of the foot, ankle, and lower leg. The term podiatry came into use first in the early 20th century United States, where it now denotes a Doctor of Podiatric Medicine , a specialist who is qualified by their...
, physiotherapists, orthopedic surgeons, specialist Ponseti nurses
Ponseti Method
The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by Dr. Ignacio V. Ponseti of the University of Iowa, USA in the 1950s, and was repopularized in 2000 by Dr. John Herzenberg in the USA and Europe and in Africa by NHS surgeon...
, or orthotists by providing braces to hold the feet in orthodox positions, serial casting, or splints called knee ankle foot orthoses (KAFO). Other orthotic options include Dennis-Brown bars with straight last boots, ankle foot orthoses and/or custom foot orthoses (CFO). In North America, manipulation is followed by serial casting, most often by the Ponseti Method
Ponseti Method
The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by Dr. Ignacio V. Ponseti of the University of Iowa, USA in the 1950s, and was repopularized in 2000 by Dr. John Herzenberg in the USA and Europe and in Africa by NHS surgeon...
. Foot manipulations usually begin within two weeks of birth. Even with successful treatment, when only one side is affected, that foot may be smaller than the other, and often that calf, as well.
Extensive surgery of the soft tissue or bone is not usually necessary to treat clubfoot; however, there are two minimal surgeries that may be required:
- TenotomyTenotomyA tenotomy is a surgical act which involves the division of a tendon.When it involves the Achilles tendon, it is called a "Achillotenotomy".It has been used in the treatment of cerebral palsy.It has also been used for hammer toe....
(needed in 80% of cases) is a release (clipping) of the Achilles tendonAchilles tendonThe Achilles tendon , also known as the calcaneal tendon or the tendo calcaneus, is a tendon of the posterior leg. It serves to attach the plantaris, gastrocnemius and soleus muscles to the calcaneus bone.- Anatomy :The Achilles is the tendonous extension of 3 muscles in the lower leg:...
– minor surgery – local anesthesiaLocal anesthesiaLocal anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with... - Anterior Tibial Tendon Transfer (needed in 20% of cases) – where the tendon is moved from the first ray (toe) to the third ray in order to release the inward traction on the foot.
Of course, each case is different, but in most cases extensive surgery is not needed to treat clubfoot. Extensive surgery may lead to scar tissue developing inside the child's foot. The scarring may result in functional, growth and aesthetic problems in the foot because the scarred tissue will interfere with the normal development of the appendage. A child who has extensive surgery may require on average two additional surgeries to correct the issues presented above.
In stretching and casting therapy the doctor changes the cast multiple times over a few weeks, gradually stretching tendons until the foot is in the correct position of external rotation. The heel cord is released (percutaneous tenotomy) and another cast is put on, which is removed after three weeks. To avoid relapse a corrective brace is worn for a gradually reducing time until it is only at night up to four years of age.
Non-surgical treatment and the Ponseti Method
Treatment for clubfoot should begin almost immediately to have the best chance for a successful outcome without the need for surgery. Over the past 10 to 15 years, more and more success has been achieved in correcting clubfeet without the need for surgery. The clubfoot treatment method that is becoming the standard in the U.S. and worldwide is known as the Ponseti MethodPonseti Method
The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by Dr. Ignacio V. Ponseti of the University of Iowa, USA in the 1950s, and was repopularized in 2000 by Dr. John Herzenberg in the USA and Europe and in Africa by NHS surgeon...
. Foot manipulations differ subtly from the Kite casting method which prevailed during the late 20th century. Although described by Dr. Ignacio Ponseti
Ignacio Ponseti
Ignacio Ponseti was a physician, specializing in orthopedics. A native of Spain, he fled the Spanish Civil War and became a faculty member and practicing physician at the University of Iowa....
in the 1950s, it did not reach a wider audience until it was re-popularized around 2000 by Dr. John Herzenberg in the USA and in Europe and Africa by NHS
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
surgeon Steve Mannion while working in Africa. Parents of children with clubfeet using the Internet also helped the Ponseti gain wider attention. The Ponseti method, if correctly done, is successful in >95% of cases in correcting clubfeet using non- or minimal-surgical techniques. Typical clubfoot cases usually require 5 casts over 4 weeks. Atypical clubfeet and complex clubfeet may require a larger number of casts. Approximately 80% of infants require an Achilles tenotomy (microscopic incision in the tendon requiring only local anesthetic and no stitches) performed in a clinic toward the end of the serial casting.
Throughout the past decade, physicians at Texas Scottish Rite Hospital for Children
Texas Scottish Rite Hospital for Children
Texas Scottish Rite Hospital for Children is a Dallas-based hospital that treats pediatric orthopedic conditions. Physicians from around the world travel to Dallas to train with their physicians in pediatric orthopedics, and research programs have resulted in major breakthroughs, including 20...
have been studying the effectiveness of both the Ponseti casting method and the French functional (physical therapy) method of stretching, massaging and taping and comparing the results with patients who have undergone surgery. Results of these studies have been presented at national and international conferences, such as the Pediatric Orthopaedic Society of North America annual meeting, the International Clubfoot Symposium, Brandon Carrell Visiting Professorship and the American Academy of Orthopaedic Surgeons annual meeting, and have been published in the Journal of Pediatric Orthopaedics.
After correction has been achieved, maintenance of correction may require the full-time (23 hours per day) use of a splint—also known as a foot abduction brace (FAB)—on both feet, regardless of whether the TEV is on one side or both, for several weeks after treatment. Part-time use of a brace (generally at night, usually 12 hours per day) is frequently prescribed for up to 4 years. Without the parents' participation, the clubfoot will almost certainly recur, because the muscles around the foot can pull it back into the abnormal position. Approximately 20% of infants successfully treated with the Ponseti casting method may require a surgical tendon transfer after two years of age. While this requires a general anesthetic, it is a relatively minor surgery that corrects a persistent muscle imbalance while avoiding disturbance to the joints of the foot.
The developer of the Ponseti Method, Dr Ignacio Ponseti, was still treating children with clubfeet (including complex/atypical clubfeet and failed treatment clubfeet) at the University of Iowa Hospitals and Clinics well into his 90s. He was assisted by Dr Jose Morcuende, president of the Ponseti International Association.
The long-term outlook for children who experienced the Ponseti Method treatment is comparable to that of non-affected children.
Watch a Video on the Ponseti Method
Botox is also being used as an alternative to surgery. Botox is the trade name for Botulinum Toxin type A. a chemical that acts on the nerves that control the muscle. It causes some paralysis(weakening) of the muscle by preventing muscle contractions (tightening). As part of the treatment for clubfoot, Botox is injected into the child’s calf muscle. In about 1 week the Botox weakens the Achilles tendon. This allows the foot to be turned into a normal position, over a period of 4–6 weeks, without surgery.
The weakness from a Botox injection usually lasts from 3–6 months. (Unlike surgery it has no lasting effect). Most club feet can be corrected with just one Botox injection. It is possible to do another if it is needed. There is no scar or lasting damage.
BC Women and Childrens Hospital
Surgical treatment
On occasion, stretching, casting and bracing are not enough to correct a baby's clubfoot. Surgery may be needed to adjust the tendons, ligaments and joints in the foot/ankle. Usually done at 9 to 12 months of age, surgery usually corrects all clubfoot deformities at the same time. After surgery, a cast holds the clubfoot still while it heals. It is still possible for the muscles in the child's foot to try to return to the clubfoot position, and special shoes or braces will likely be used for up to a year or more after surgery. Surgery will likely result in a stiffer foot than nonsurgical treatment, particularly over time.Without any treatment, a child's clubfoot will result in severe functional disability, however with treatment, the child should have a nearly normal foot. He or she can run and play without pain and wear normal shoes. The corrected clubfoot will still not be perfect, however; a clubfoot usually stays 1 to 1½ sizes smaller and somewhat less mobile than a normal foot. The calf muscles in a leg with a clubfoot will also stay smaller.
Long-term studies of adults with post-club feet, especially those with substantial numbers of surgeries, may not fair as well in the long term, according to Dobbs, et. al., A percentage of adults may require additional surgeries as they age, though there is some dispute as to the effectiveness of such surgeries, in light of the prevalence of scar tissue present from earlier surgeries.
Famous people
Claudius
Claudius , was Roman Emperor from 41 to 54. A member of the Julio-Claudian dynasty, he was the son of Drusus and Antonia Minor. He was born at Lugdunum in Gaul and was the first Roman Emperor to be born outside Italy...
, Egyptian pharaoh Tutankhamun
Tutankhamun
Tutankhamun , Egyptian , ; approx. 1341 BC – 1323 BC) was an Egyptian pharaoh of the 18th dynasty , during the period of Egyptian history known as the New Kingdom...
, statesman Prince Talleyrand, Civil War politician Thaddeus Stevens
Thaddeus Stevens
Thaddeus Stevens , of Pennsylvania, was a Republican leader and one of the most powerful members of the United States House of Representatives...
, comedian Damon Wayans
Damon Wayans
Damon Kyle Wayans is an American stand-up comedian, writer and actor, one of the Wayans brothers.-Early life:Wayans was born in New York City, New York, the son of Elvira, a homemaker and social worker, and Howell Wayans, a supermarket manager...
, actor Gary Burghoff, and Eric The Midget
Eric the Midget
Eric Lynch , better known as Eric the Midget or Eric the Bedhumper, is known solely as a fan of The Howard Stern Show. He is considered a part of the Wack Pack, though membership is unofficial. Lynch is tall, weighs , and uses a motorized wheelchair, in addition to various other afflictions...
from The Howard Stern Show, football players Steven Gerrard
Steven Gerrard
Steven George Gerrard MBE is an English footballer who plays for and captains Premier League club Liverpool. He also has 89 caps for the England national team. He has played much of his career in a centre midfielder role, but he has also been used as a second striker and right winger...
and Miguel Riffo
Miguel Riffo
Miguel Riffo is a Chilean footballer, who plays defender currently for Santiago Morning.-Club career:Riffo began in the youth ranks of Colo-Colo, making his professional debut in 2001 against Unión San Felipe...
, sledge hockey player Matt Lloyd
Matt Lloyd (Paralympian)
Matthew "Matt" Lloyd is a British paralympian who was born with spina bifida and two club feet. He has competed in Ice sledge hockey at the 2006 Winter Paralympics, in Sitting volleyball at the 2007 European Championships, and is credited with inventing the sport of Inline sledge hockey...
, a Paralympian, mathematician Ben Greenberg, and filmmaker Jennifer Lynch
Jennifer Lynch
Jennifer Chambers Lynch is an American film director and screenwriter, best known for writing the book The Secret Diary of Laura Palmer and for being Hollywood's youngest female writer and director with her 1993 feature film Boxing Helena. -Early life:Lynch was born in Philadelphia, Pennsylvania,...
.
The British Romantic poet George Gordon, Lord Byron had a clubfoot, which caused him much humiliation.
Comedian, musician, and actor Dudley Moore
Dudley Moore
Dudley Stuart John Moore, CBE was an English actor, comedian, composer and musician.Moore first came to prominence as one of the four writer-performers in the ground-breaking comedy revue Beyond the Fringe in the early 1960s, and then became famous as half of the highly popular television...
was born with a club foot. This was mostly unknown to the public as he wore one shoe with a slightly bigger sole to compensate when walking.
The figure-skater Kristi Yamaguchi
Kristi Yamaguchi
Kristine Tsuya "Kristi" Yamaguchi-Hedican is an American figure skater. She is the 1992 Olympic Champion in ladies' singles. Yamaguchi also won two World Figure Skating Championships in 1991 and 1992 and a U.S. Figure Skating Championships in 1992. She won one junior world title in 1988 and two...
was born with a clubfoot, and went on to win gold medals at both the Olympics and World Championships. The soccer star Mia Hamm
Mia Hamm
Mariel Margaret "Mia" Hamm is a retired American soccer player. Hamm played many years as a forward for the United States women's national soccer team and was a founding member of the Washington Freedom. Hamm has scored more international goals in her career than any other player, male or female,...
was born with the condition. Baseball pitcher Larry Sherry
Larry Sherry
Lawrence Sherry was an American right-handed relief pitcher in Major League Baseball who spent most of his career with the Los Angeles Dodgers and Detroit Tigers...
, the 1959 World Series MVP, was born with club feet, as was pitcher Jim Mecir
Jim Mecir
James Jason Mecir is an American former baseball player. He played for five teams in an 11-year career, and retired from the Florida Marlins in . He was a right-handed pitcher....
, and both enjoyed long and successful careers. In fact, it was suggested in the book Moneyball that Mecir's club foot contributed to his success on the mound; it caused him to adopt a strange delivery that "put an especially violent spin" on his screwball
Screwball
A screwball , is a baseball pitch that is thrown so as to break in the opposite direction of a slider or curveball. Depending on the pitcher's arm angle, the ball may also have a sinking action....
, his specialty pitch. The San Francisco Giants
San Francisco Giants
The San Francisco Giants are a Major League Baseball team based in San Francisco, California, playing in the National League West Division....
held the record as the team with the all-time highest number of players with clubbed feet as of July 2010, and Freddy Sanchez
Freddy Sanchez
Frederick Phillip "Freddy" Sanchez, Jr. is a Major League Baseball second baseman for the San Francisco Giants. Sanchez has previously played for the Boston Red Sox and the Pittsburgh Pirates and the San Francisco Giants...
, one of its infielders, cites his ability to overcome the defect as a reason for his success. Tom Dempsey
Tom Dempsey
Thomas Dempsey is a former American football placekicker in the National Football League for the New Orleans Saints , Philadelphia Eagles , Los Angeles Rams , Houston Oilers and Buffalo Bills . He attended high school at San Dieguito High School and played college football at Palomar College...
of the New Orleans Saints
New Orleans Saints
The New Orleans Saints are a professional American football team based in New Orleans, Louisiana. They are members of the South Division of the National Football Conference of the National Football League ....
, born with a right club foot and no toes (this was his kicking foot), kicked an NFL record 63 yards (57.6 m) field goal. This kick became famous as the longest NFL field goal in history. Former NFL quarterback Troy Aikman
Troy Aikman
Troy Kenneth Aikman is a former American football quarterback for the Dallas Cowboys in the National Football League. The number one overall draft pick in 1989, Aikman played twelve consecutive seasons as quarterback with the Cowboys...
beat being born with a clubfoot to enjoy a productive Hall of Fame
Hall of Fame
A hall of fame, wall of fame, walk of fame, walk of stars or avenue of stars is a type of attraction established for any field of endeavor to honor individuals of noteworthy achievement in that field...
career.
The Nazi
Nazi Germany
Nazi Germany , also known as the Third Reich , but officially called German Reich from 1933 to 1943 and Greater German Reich from 26 June 1943 onward, is the name commonly used to refer to the state of Germany from 1933 to 1945, when it was a totalitarian dictatorship ruled by...
Propaganda Minister
Ministry of Public Enlightenment and Propaganda
The Reich Ministry of Public Enlightenment and Propaganda was Nazi Germany's ministry that enforced Nazi Party ideology in Germany and regulated its culture and society. Founded on March 13, 1933, by Adolf Hitler's new National Socialist government, the Ministry was headed by Dr...
Joseph Goebbels
Joseph Goebbels
Paul Joseph Goebbels was a German politician and Reich Minister of Propaganda in Nazi Germany from 1933 to 1945. As one of Adolf Hitler's closest associates and most devout followers, he was known for his zealous oratory and anti-Semitism...
had a right clubfoot (possibly incurred after birth as a complication of osteomyelitis
Osteomyelitis
Osteomyelitis simply means an infection of the bone or bone marrow...
), a fact hidden from the German public by censorship. Because of this malformation, Goebbels needed to wear a leg brace. That, plus his short stature, led to his rejection for military service in World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
.
De Witt Clinton Fort
De Witt Clinton Fort
De Witt Clinton Fort . He was a member of the Texas House of Representatives and soldier in the Confederate army during the American Civil War.-Personal background:...
, who served in the Confederate Army as a captain, was born with a clubfoot, and he was known during the American Civil War as Captain "Clubfoot" Fort, C.S.A.
Tutankhamun
Tutankhamun
Tutankhamun , Egyptian , ; approx. 1341 BC – 1323 BC) was an Egyptian pharaoh of the 18th dynasty , during the period of Egyptian history known as the New Kingdom...
had a club foot and a cleft palate, and it is likely that he needed a cane to walk.
Princess Isabella of Denmark was born with a clubfoot as shown in this photograph at one year old and in this photograph at three years old.
In literature
- The main character, Philip Carey, in W. Somerset MaughamW. Somerset MaughamWilliam Somerset Maugham , CH was an English playwright, novelist and short story writer. He was among the most popular writers of his era and, reputedly, the highest paid author during the 1930s.-Childhood and education:...
's novel Of Human BondageOf Human BondageOf Human Bondage is a novel by W. Somerset Maugham. It is generally agreed to be his masterpiece and to be strongly autobiographical in nature, although Maugham stated, "This is a novel, not an autobiography, though much in it is autobiographical, more is pure invention." Maugham, who had...
, has a club foot, a central theme in the work. - Hippolyte Tautain, the stable man at the Lion D'Or public house in Gustave FlaubertGustave FlaubertGustave Flaubert was a French writer who is counted among the greatest Western novelists. He is known especially for his first published novel, Madame Bovary , and for his scrupulous devotion to his art and style.-Early life and education:Flaubert was born on December 12, 1821, in Rouen,...
's novel Madame BovaryMadame BovaryMadame Bovary is Gustave Flaubert's first published novel and is considered his masterpiece. The story focuses on a doctor's wife, Emma Bovary, who has adulterous affairs and lives beyond her means in order to escape the banalities and emptiness of provincial life...
is unsuccessfully treated for clubfoot by Charles Bovary, leading to the eventual amputation of his leg. - Charlie Wilcox, the main character in Sharon McKay's novel Charlie WilcoxCharlie WilcoxCharlie Wilcox is a children's novel by Sharon E. McKay about a Canadian boy in World War I. The novel won the Geoffrey Bilson Award and the Violet Downey Award. It is followed by a sequel, Charlie Wilcox's Great War, published in 2003....
had a club foot. - In Yukio MishimaYukio Mishimawas the pen name of , a Japanese author, poet, playwright, actor and film director, also remembered for his ritual suicide by seppuku after a failed coup d'état...
's seminal novel The Temple of the Golden PavilionThe Temple of the Golden PavilionThe Temple of the Golden Pavilion is a novel by the Japanese author Yukio Mishima. It was published in 1956 and translated into English by Ivan Morris in 1959.-Plot introduction:...
the character Kashiwagi has club feet which parallels the stutter of the main character, Mizoguchi. - In David EddingsDavid EddingsDavid Eddings was an American author who wrote several best-selling series of epic fantasy novels.-Biography:...
' Malloreon series, Senji the sorcerer has a club foot. - In Caroline LawrenceCaroline LawrenceCaroline Lawrence is an English American author, best known for The Roman Mysteries series of historical novels for children. The series is about a Roman girl called Flavia and her three friends: Nubia , Jonathan and Lupus...
's Roman Mysteries series, a character called Vulcan the blacksmith appears in the book "The Secrets of Vesuvius". He reveals that he gained the nickname because of his club foot. - In Bernard CornwellBernard CornwellBernard Cornwell OBE is an English author of historical novels. He is best known for his novels about Napoleonic Wars rifleman Richard Sharpe which were adapted into a series of Sharpe television films.-Biography:...
's The Warlord ChroniclesThe Warlord ChroniclesThe Warlord Chronicles is a trilogy of books about Arthurian Britain written by Bernard Cornwell...
Mordred, King of Dumnonia, has a club foot that is often used as a symbol for his ugliness and weakness as a ruler. - In Daniel KeyesDaniel KeyesDaniel Keyes is an American author best known for his Hugo award-winning short story and Nebula award-winning novel Flowers for Algernon. Keyes was given the Author Emeritus honor by the Science Fiction and Fantasy Writers of America in 2000.-Early life and career:Keyes was born in Brooklyn, New...
's Flowers for AlgernonFlowers for AlgernonFlowers for Algernon is a science fiction short story and subsequent novel written by Daniel Keyes. The short story, written in 1958 and first published in the April 1959 issue of The Magazine of Fantasy & Science Fiction, won the Hugo Award for Best Short Story in 1960...
Gimpy, one of Charlie's co-workers at the bakery, has a club foot. - In Heinrich von KleistHeinrich von KleistBernd Heinrich Wilhelm von Kleist was a poet, dramatist, novelist and short story writer. The Kleist Prize, a prestigious prize for German literature, is named after him.- Life :...
's play The Broken JugThe Broken JugThe Broken Jug is a comedy written by the German playwright Heinrich von Kleist. Kleist first conceived the idea for the play in 1801, upon looking at a copper engraving in Heinrich Zschokke's house entitled "Le juge, ou la cruche cassée." In 1803, challenged over his ability to write comedy,...
, the main character Judge Adam has a club foot, betraying him as the culprit who broke the jug.
In animals
Equus (genus)
Equus is a genus of animals in the family Equidae that includes horses, donkeys, and zebras. Within Equidae, Equus is the only extant genus. Like Equidae more broadly, Equus has numerous extinct species known only from fossils. This article deals primarily with the extant species.The term equine...
. The condition is characterized by a strongly upright pastern
Pastern
The pastern is a part of the leg of a horse between the fetlock and the top of the hoof. It incorporates the long pastern bone and the short pastern bone , which are held together by two sets of paired ligaments to form the pastern joint...
and a corresponding rotation of the coffin bone in the hoof
Horse hoof
A horse hoof is a structure surrounding the distal phalanx of the 3rd digit of each of the four limbs of Equus species, which is covered by complex soft tissue and keratinised structures...
. The condition often affects only one foot. Severity varies, with some animals usable for work or riding, and others unsound for life. Careful farrier
Farrier
A farrier is a specialist in equine hoof care, including the trimming and balancing of horses' hooves and the placing of shoes on their hooves...
work on the hooves can lessen the severity of many cases, and in certain circumstances surgery may be beneficial. The visible outward appearance of a club foot has different possible origins that include a genetic predisposition to the condition, a congenital defect formed while the animal is in the womb, or problems with diet and bone development during the early post-natal period. Certain horse breeds appear to be more predisposed to the condition than others, but research has yet to identify the genes involved.
A grading scale exists to assess the severity of club feet, which are caused by a deep digital flexor contraction syndrome. When the muscle fibers of the upper leg's deep ditigal flexor muscle contract excessively, this affects the tendon of the same name that comes off of this muscle group and attaches at the bottom of the coffin bone. A constant upward pull by the tendon on the coffin bone and other structure of the horse's hoof creates the condition. While many young foal
Foal
A foal is an equine, particularly a horse, that is one year old or younger. More specific terms are colt for a male foal and filly for a female foal, but these terms are used until the horse is age three or four. When the foal is nursing from its dam , it may also be called a suckling...
s are born with somewhat upright pasterns, the condition may resolve naturally or with minimal intervention if begun early. However, some cases are so severe that more drastic treatment may be required.