What is the evaluation approach for congenital deformity of the newborn foot?

From the Guidelines

Evaluation of a newborn foot deformity should begin with a thorough physical examination to determine if the condition is flexible or rigid, and early referral to pediatric orthopedics is recommended for rigid deformities or those that don't improve with gentle stretching. The physical examination should include observation of the foot position at rest, followed by gentle manipulation to assess correctability. Common deformities include clubfoot (talipes equinovarus), metatarsus adductus, calcaneovalgus, and vertical talus. For clubfoot, the Pirani or Dimeglio scoring system can be used to assess severity 1.

Key Considerations

• Imaging is typically not needed initially for most deformities, but may be considered if the diagnosis is unclear or if there are concerns for underlying bone abnormalities.
• X-rays are the first-line imaging choice when needed, with ultrasound sometimes useful for dynamic assessment.
• Treatment timing is crucial, with many interventions most effective when started within the first few weeks of life.
• For mild, flexible deformities, stretching exercises taught to parents may be sufficient.
• More severe deformities like clubfoot typically require the Ponseti method, involving serial casting followed by bracing.

Importance of Early Intervention

Early intervention is essential because newborn cartilage is malleable, allowing for correction with non-surgical methods in many cases, whereas delayed treatment may necessitate more invasive approaches. The evidence from 1 highlights the importance of early detection and intervention in cases of skeletal dysplasia, which can sometimes present with foot deformities. Although the study from 1 focuses on foot care in diabetes, it emphasizes the importance of comprehensive foot evaluation, which can be applied to the assessment of newborn foot deformities as well.

Recommendations

• Perform a thorough physical examination to assess the deformity.
• Refer to pediatric orthopedics for rigid or uncorrectable deformities.
• Consider imaging if the diagnosis is unclear or if there are concerns for underlying bone abnormalities.
• Start treatment early, as many interventions are most effective when initiated within the first few weeks of life.

From the Research

Evaluation of Newborn Foot Deformity

To evaluate a newborn foot deformity, a thorough examination is essential, including:

• Assessment of vascular, dermatologic, and neurologic status of the lower extremities 2
• Observation, palpation, and evaluation of joint range of motion in both feet 2
• Identification of common newborn foot abnormalities, such as:
  • Metatarsus adductus
  • Clubfoot deformity
  • Calcaneovalgus (flexible flatfoot)
  • Congenital vertical talus (rigid flatfoot)
  • Multiple digital deformities (polydactyly, syndactyly, overlapping toes, and amniotic bands) 2, 3

Diagnostic Approach

Most deformities can be diagnosed easily with physical examination alone, using few diagnostic studies 2. A review of literature suggests that assessment techniques for the neonatal foot remain the same, but recent nonsurgical treatment options are available for a variety of neonatal foot deformities 4.

Treatment Options

Treatment of newborn foot deformities depends on the severity of the deformity, and may include:

• Conservative measures, such as observation, stretching, and splinting, which can be performed easily in the family medicine setting 2
• Referral to a subspecialist with expertise in correcting lower extremity deformities in children for cases that require surgical correction 2
• Novel devices, such as orthoses, which have demonstrated equal effectiveness to casting and may allow for primary care physicians to treat metatarsus adductus without the need for referral 5