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-& Etiology of the Clubfoot, PreClinical Clubfoot, Primus Metatarsus Supinatus
Deformities
by Brian A Rothbart PhO(more info)
listed in bodywork, originally published in issue 279 - June 2022
Introduction
Congenital talipes equinovarus (CTEV), to this day, has no general consensus as to its’ etiology in normal newborns.
Many theories have been proposed, including such factors as increased intrauterine pressure, smoking, family
history as well as genetic.
This study encompasses the sequential examination of the prenatal foot plates during late embryogenesis and early
fetalgenesis in which the foot inchoates as a limb bud and then progresses through a series of forms, clubfoot to
plantargrade. If the foot’s ontogenetic growth is prematurely arrested during this time of prenatal development, the
infant is born with a Clubfoot Deformity, a PreClinical Clubfoot Deformity or a Primus Metatarsus Supinatus Foot
Deformity, depending at which stage the abortive ontogenesis occurred.
Discussion
The prenatal foct develops in 2 specific and predictable way. It first appears as a limb bud, Carnegie Stage 15 (35-
38 days post fertilization). [Figure 1]Faure 1, Embrvo, Cameale Stage
Passing through Carnegie Stages 17-19 (41-51 days pf) the plantar surfaces of the foot pads rotate inward from a
cephalad position [Figure 2] to a vertical position [Figure 3].
Figure 2. Embryo, Carneale stage 17id
Figure 3. Embryo, Carnegie Stage 19
At this stage, the soles of the feet are facing one another (e.0., in supinatus). At Camegie Stage 23 (56-60 days
pf), [Figure 4] the developing foot has a clubfoot shape. [Figure 5]
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Figure 4, Embryo, Camegie Stage 23ones
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Figure 5. Clubfoot shape
It continues its’ torsional growth, progressing through a prediinical clubfoot shape (Figure 6) and a primus
metatarsus supinatus shape [Figure 7], until it reaches its’ adult (Plantargrade) shape [Figure 8),If any of these prenatal shapes persist into the postnatal foot, they are considered deformations, and are so
named. They are The Clubfoot Deformity, the PreClinical Clubfoot Deformity and the Primus Metatarsus Supinatus
Deformity (aka Rothbarts Fost).[1]
During foetalaenesis, if we were to look inside the womb and watch the foot's torsional arowth unfold in real time,
this is what we would cbserve:
At approximately week 8 (56-60 days post fertilization), the foetal foot has a clubfoot shape. Specifically, the
embryological medial and lateral columns of the feet are structurally twisted inward, that is, in supinatus. If the
torsional growth is arrested at this stage, the baby is born with 2 CTEV (Clubfoot Deformity).[2]
At approximately week 9pf, the foetal foot has a preclinical clubfoct shape. The lateral column supinatus (the
inward structural twist of the cubsid, intermediate and lateral cuneiforms, four lesser metatarsals and respactive
phalanges)is no longer present. The calcaneal supinatus (the inward structural twist of the heel bone) is decreased,
but the medial column supinatus (the inward structural twist of the talar head and neck, navicular, internal
cuneiform, 1st metatarsal, proximal phalanx and hallux) persists. If the torsional growth Is arrested at this stage,
the baby is bom with a Preciinical Clubfoot Deformity.[3]
At approximate week 10pf, the foetal foot has @ primus metatarsus supinatus shape. The calcaneel supinatus is no
longer present. The medial column supinatus persists but has decreased. If the torsional growth is arrested at this,
stage, the baby is born with a Primus Metatarsus Supinatus Deformity. [4]
This structural deformation was recently been confirmed in a weight bearing computed tomography study in which a
rotational position (supinatus) was recorded in all the mecial colurmn bones In patients with different foot and ankle
problems,(5] in a weight-bearing Case-Control cadaver study(6) and in a non-weight-bearing cadaver study.(7]
A protocol was developed to accurately measure the medial column supinatus using calibrated
underneath the 1** metatarsal head.[8] A single blind study involving 4 examiners and 32 volunteers tested the
accuracy of this technique, resulting in an intrarater and interrater reliability ranging from 0.50 to 0.95. The authors
concluded that this measuring protocol was reliable.[9]
ovedges
At week 36pf, the prenatal foot has nearly completed its torsional growth. The medial column supinatus is no longer
resent. The baby is born with a Plantargrade foot (the soles of the feet are perpendicular to plumb line of the
body).
Summation
+ Based on the sequential analysis of the embryo’s foot plates, it can be extrapolated that if the foot's torsional,
development is arrested at approximately week Spf, the baby is bom with a Clubfoot Deformity;
+ If the foct’s torsional development is arrested at approximately week 9pf, the baby is born with 2 PreClinical
Clubfoot Deformity;
+ If the foct’s torsional development is arrested at approxi
Metatarsus Supinatus (aka Rothbarts Foot) Deformity;
+ Ifthe foct’s prenatal development is completed, the baby is born with a Plantargrade (normal) foot.
born with a Primus
‘ately week 10pf, the baby iReferences
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A foundation for a finite
tation Research and
ing forefoot posting for orthotic fabrication.