Clubfoot, or congenital talipes equinovarus, is the most common musculoskeletal birth defect, with an incidence of 1-3:1000 worldwide, the highest prevalence being in people of indigenous Hawaiian and Maorian descent. Clubfoot occurs twice as frequently in males as in females. It is typically diagnosed at birth in a child with no other abnormalities but can occasionally be seen before birth on ultrasound.

The pathogenesis of clubfoot is not well understood. Eighty percent of cases are idiopathic; the remaining 20% are related to other genetic / syndromic etiologies. Spina bifida is the most common intrinsic cause. Clubfoot tends to be bilateral (in 30%-60% of cases). Risk factors include a family history of clubfoot, pointing to a possible genetic component, with increased occurrence within families.

The appearance of clubfoot is due to muscle, cartilage, bone, and vascular deformities. The foot, calf, and leg may be smaller and shorter than the normal limb. A common physical examination finding is less than 90 degrees of dorsiflexion in the ankle.

There are 2 grading systems: the Pirani score and the Dimeglio grade. The Pirani score is most commonly used, in which 6 clinical features, including hindfoot and forefoot features, are graded as 0, 0.5, or 1. Higher scores typically indicate worse deformities.