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ULY CLINIC

24 Septemba 2025, 07:22:53

Congenital foot malposition

Congenital foot malposition refers to anomalous positioning of the foot present at birth. It is observed in approximately 0.4% of neonates. The malposition may result from:

Fetal positioning in utero (positional deformities)
Neuromuscular disorders affecting tone or movement
Structural malformations of joints, bones, or connective tissue

Pathophysiology

Positional factors: Limited intrauterine space can force the foot into abnormal postures.
Neuromuscular causes: Hypertonia or hypotonia alters normal foot alignment.
Structural anomalies: Abnormal bone formation, ligament laxity, or joint malformations disrupt normal foot orientation.

Examination Technique

Observation at rest: Place the neonate supine and observe the foot’s position of comfort.
Observation during activity: Watch the foot during spontaneous kicking or movement.
Passive assessment: Gently manipulate the foot to determine range of motion of the ankle and foot.
Documentation: Note which deformities are fixed versus flexible and whether one or both feet are involved.

Clinical Features

Feature	Manifestation
Foot alignment	Varus, valgus, equinus, or combination
Flexibility	Fixed deformity vs. correctable with passive movement
Symmetry	Unilateral or bilateral involvement
Associated findings	Muscle tone abnormalities, limb length discrepancy, other congenital anomalies

Differential Diagnosis

Condition	Key Feature	Notes
Positional deformity	Flexible, correctable with manipulation	Usually resolves spontaneously or with gentle stretching
Congenital clubfoot (talipes equinovarus)	Rigid foot deformity with varus, adductus, and equinus	Requires orthopedic intervention
Neuromuscular disorders	Malposition with abnormal tone or movement	Examples: cerebral palsy, spina bifida
Syndromic or connective tissue disorders	Foot malformations plus other anomalies	Examples: arthrogryposis, Ehlers-Danlos
Skeletal dysplasia	Structural anomalies in bones	May involve other limbs and growth abnormalities

Pediatric considerations

Early detection is critical to guide orthopedic intervention.
Flexible deformities may respond to stretching, splinting, or casting.
Fixed deformities often require orthopedic referral and sometimes surgical correction.

Geriatric considerations

Not typically applicable, as this is a congenital condition.
Long-term sequelae may include gait abnormalities, arthritis, or compensatory musculoskeletal issues.

Limitations

Differentiating between positional (flexible) and structural (rigid) malpositions requires careful assessment.
Subtle deformities may be overlooked without systematic neonatal musculoskeletal examination.

Patient counseling

Explain the type and severity of the malposition.
Discuss potential for spontaneous correction versus need for intervention.
Stress early follow-up with pediatric orthopedics if deformity is rigid or progressive.
Provide guidance on physical therapy or splinting when indicated.

Conclusion

Congenital foot malposition is an abnormal foot position present at birth, resulting from positional, neuromuscular, or structural factors. Careful neonatal assessment distinguishes flexible from fixed deformities, guides management, and improves long-term musculoskeletal outcomes.

References

Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146–1153.
Wynne-Davies R. Classification and incidence of congenital foot deformities. J Bone Joint Surg Br. 1964;46:445–462.
Beaty JH, Kasser JR. Rockwood and Wilkins’ Fractures in Children. 9th ed. Philadelphia, PA: Wolters Kluwer; 2019.
Nelson Textbook of Pediatrics, 22nd ed. Philadelphia, PA: Elsevier; 2021.