Source: Katz A, Kreiner M, Korain Blank P, et al. Developmental outcomes in children with clubfoot: a twin study comparing affected and unaffected siblings. J Pediatr Orthop. 2025;45(10):e928-e932; doi: 10.1097/BPO.0000000000003049.Investigators from Shaare Zedek Medical Center, Jerusalem, Israel, conducted a study to assess whether children with clubfoot are at risk for developmental delays. For the study, they compared developmental outcomes in pairs of twins, with 1 twin in each dyad being affected with clubfoot. All participants with clubfoot were treated with the Ponseti method, involving serial casting. The severity of clubfoot at birth, and after treatment, was classified with a Pirani score. Possible scores range from 0 to 6, with higher scores indicating increasing severity. Development was assessed when study participants were 7 months to 7 years old with the Mullen Scales of Early Learning (MSEL) test, administered to each child by a single evaluator. The MSEL includes 5 domains, including gross motor skills, fine motor skills, visual reception, receptive language, and expressive language. Scores on each section were converted to a developmental quotient (DQ). The DQ for each domain was compared in children with, or without, clubfoot using the Wilcoxon paired signed rank test.Development was assessed in 13 pairs of twins, with 2 pairs of monozygotic and 11 pairs of dizygotic twins. At birth, severity of clubfoot, as measured using the Pirani score, in the affected child in each twin pair ranged from 3 to 5.5 (median score 5). After treatment with a median of 5 casts, the median Pirani score was 0. Mean DQ on the domains in the MSEL for study participants with clubfoot and those unaffected, respectively, were 69 vs 65 for gross motor skills, 114 vs 103 for fine motor skills, 92 vs 97 for visual reception, 100 vs 90 for receptive language, and 100 vs 82 for expressive language. On paired analysis, there was no significant difference in DQ for any domain between twins with clubfoot and their unaffected sibling.The authors conclude that there was no evidence of increased risk of developmental delays in children with a clubfoot compared to their unaffected twin, but caution that interpretation of their results is limited by the modest sample size of the study.Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The goals of clubfoot treatment are to achieve a painless, plantigrade, flexible foot that allows mobility and comfortable shoe wear.1 The current treatment method for clubfoot was developed by Ponseti and includes serial casting of the lower leg weekly for about 6 weeks followed by a tendo-achilles tenotomy and another cast for about 4 weeks, followed by a foot abduction brace for about 3 years to maintain correction and prevent recurrence.2 Untreated clubfoot can significantly impair walking and negatively impact physical and psychological development.3Prior studies have shown contrasting results about the relationship of treated clubfoot and motor and cognitive delays.4-6 Some of these studies may be biased due to insu?cient demographic matching between study groups.7The current researchers attempted to clarify whether developmental delays in children with clubfoot exist and minimize prior bias by comparing the development of children with clubfoot to their unaffected twin living in the same household. A twin study focuses the comparison on children with similar genetic and environmental backgrounds. In addition, this is the first study to evaluate the developmental characteristics of children with clubfoot compared to their unaffected twin. Thirteen pairs of twins were evaluated with the MSEL test, an age-stratified test assessing 5 developmental domains. Overall, no significant differences were observed in physical or cognitive development in children with clubfoot compared to their twin without a clubfoot. Parents probably can therefore be reassured that the presence of clubfoot in their baby is not associated with developmental delays.Clubfoot, when treated effectively, is apparently not associated with developmental delays. (See AAP Grand Rounds. 2019;41440.)8
A Sun, study studied this question.