The causes of congenital club foot.

I devoted much attention to the nature of these distortions, from the circumstance of my being afflicted with Talipes in the left foot.' William Little (1839)Hippocrates was the first to suggest that perma- nent crippling can follow abnormal intrauterine pressure.More recently, Browne (1936) has been the foremost exponent of the view that this is a major cause of congenital club feet.The theory had first been challenged in the early 19th century by the authors of several very detailed studies on the condition.Little (1839) felt that the variety of deformities found in club feet could not be accounted for by the pressure theory, or by the theory of arrested foetal development, as suggested by von Walther (1833).Little, like Guerin (1839), con- sidered that as in club foot of postnatal onset, congenital talipes is due to muscle paralysis or spasm.Adams (1873) also inclined towards this 'dynamic' theory, but thought that in some cases, particularly of talipes calcaneous or calcaneovalgus, the origin was mechanical distortion.All authors acknowledge the strong family history in about one-tenth of patients with foot deformities, and the frequent coexistence of other congenital defects.Ehrenfried (1912) found associated anomalies in 13 * 4 % of the 232 cases he investigated.Crabbe (1960) in a review of 172 patients with congenital talipes found associated congenital defects in 11 * 2 %.He pointed out that mechanical compression could not account for the significant increase of anomalies such as arachnodactyly, cleft palate, webbing of the toes, and sacral agenesis, which are probably faults in mesenchymal differ- entiation.Wynne-Davies (1964) has recently re- ported the results of family studies on 635 patients with club feet, and also concluded that defective formation of connective tissue was an important aetiological factor.Previous investigations have been carried out on patients attending orthopaedic clinics, so that babies with associated lethal malformations or those with very slight deformities have been excluded.A study varus while her sib was in the 'other' group.There were, therefore, 3 less mothers than there were patients with foot deformities, 167 compared with 170 controls.Only one of each of the 5 pairs of twins in the series had been affected.Two had been like sex pairs but in both the placenta was considered to be binovular in type, and it is, therefore, probable that all 5 pairs were dizygotic.548