Congenital clubfoot anyone?

This gentleman, a longtime patient came in for new orthotics, as his old ones were 10 years old. From the pedographs above, you can see it is his LEFT foot. 

Note the following:

• shortened apparent foot length left compared to right (the foot is merely deformed and plantarflexed)
  
• The increased plantar pressures laterally, from the foot being supinated 
  
• increased arch height L > R
  
• clawing of digits 2-4 to provide stability
  

This case made me think about some common issues that you may be wondering about if you see these folks. 

There are several things you should think about:

• People with clubfoot generally have a high arched, rigid, cavus foot. 
  

• These folks generally are fixed in some degree of plantar flexion.
  

• Because of the plantar flexed posture of their foot, they generally have a loss of a ankle rocker
  

• If you utilize an orthotic with these patients, you need to make sure that there is significant ramp delta (heel higher than the 1st metatarsal)
  

• Clubfoot can often be unilateral.
  

• Clubfoot is usually not congenital
  

• Gait training and balance (proprioceptive) work can be especially helpful in these cases.