The clubfoot over the centuries

The aim of this paper is to review all treatment methods of the clubfoot over the years through the documentation present in the literature and art with the aim of better understanding the pathoanatomy of the deformity, but to also clarify factors that allow a safe, logical approach to clubfoot management. The initial part of this paper traces the most representative iconographic representations of clubfoot in history to describe how his presence was witnessed since ancient times. Hippocrates, the father of medicine, was the first to present written references about treatment methods of clubfoot. After the dark period of the Middle Ages, during the Renaissance, there were more detailed studies on the disease, with the creation of the first orthopedic orthotics, designed to correct the deformity with the help of famous names in medicine's history. In the XVIII century, as we witness the birth of orthopedics as a distinct discipline in medicine, more and more brilliant minds developed complex orthoses and footwear with the aim of obtaining a proper correction of the deformity. In the last part of the paper, there is a description of the main surgical techniques developed over the years until the return to conservative treatment methods such as the Ponseti method, internationally recognized as the gold standard of treatment, despite the presence of some unresolved issues such as the possible recurrence of the disease.

Update on clubfoot: etiology and treatment

Although clubfoot is one of the most common congenital abnormalities affecting the lower limb, it remains a challenge not only to understand its genetic origins but also to provide effective long-term treatment. This review provides an update on the etiology of clubfoot as well as current treatment strategies. Understanding the exact genetic etiology of clubfoot may eventually be helpful in determining both prognosis and the selection of appropriate treatment methods in individual patients. The primary treatment goal is to provide long-term correction with a foot that is fully functional and pain-free. To achieve this, a combination of approaches that applies the strengths of several methods (Ponseti method and French method) may be needed. Avoidance of extensive soft-tissue release operations in the primary treatment should be a priority, and the use of surgery for clubfoot correction should be limited to an "a la carte" mode and only after failed conservative methods.

LEVEL OF EVIDENCE

Level V, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Club-foot through the centuries

This is a study of the history of club-foot from ancient times up to the present. It embraces not only the clinical aspects of the deformity but also its social implications, particularly of its early history when the attitude of society towards the lame and crippled in general and to foot deformities in particular is discussed. Relevant references from Greek mythology and also from the Old Testament are quoted. A close study is made of the old Chinese custom of foot-binding which produced club-foot like deformities which became a symbol of social standing. Inevitably, like most other medical conditions, club-foot has been well described by Hippocrates and it is a sobering thought that his concepts of causation and his principles of treatment are as valid today as they were 2300 years ago. This paper also briefly describes club-foot in history and art. Encouraged by society's compassionate approach towards the cripple, famous painters of the 17th century produced sympathetic portraits of the deformed and the club-footed. Well-known personalities who suffered from club-foot, such as Lord Byron and Sir Walter Scott, are mentioned and it is shown how the deformity affected them. The saga of the physician and surgeon W.J. Little, himself afflicted by club-foot, is unfolded. His life was dedicated to the study and relief of his own deformity and later he devoted his efforts towards the cure of his fellow sufferers. W.J. Little has done so much for the advancement of orthopaedic surgery that Sir Robert Jones called him the father of orthopaedic surgery; yet at heart W.J. Little was a physician! Another physician, Nicholas André, deserves the title of father of orthopaedic surgery. He coined the word 'orthopaedia' and laid down the principles of preventing and correcting deformities and he detailed the conservative management of club-foot. The treatment of the deformity came into the hands of bone setters and instrument makers and it was almost beneath the dignity of a surgeon to treat it. Yet, with the advent of tenotomy, popularised by Little, surgical treatment of the condition increased, aided by the development of antiseptic and aseptic technique and anaesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)