The Association between Idiopathic Clubfoot and Increased Internal Hip Rotation

Clinical observation suggests the coexistence of increased internal hip rotation in limbs with clubfoot, thereby providing an additional, and perhaps overlooked, site of deformity to account for an intoeing gait in these limbs. Furthermore, assuming a genetic basis exists for exaggerated femoral and/or acetabular anteversion, which are the possible cause(s) for increased internal hip rotation, this association could provide another key to the multifactorial etiology of clubfoot. We asked whether such an association exists and retrospectively reviewed 114 children (178 clubfeet). We then tested for an association between clubfoot and increased internal hip rotation. These rotational measurements were compared with published normative data on torsion in children. In cases of unilateral clubfoot, an additional analysis compared the rotational profiles of the affected and unaffected extremities. Increased internal hip rotation occurred more frequently in limbs with idiopathic clubfoot. In patients with unilateral clubfoot, the affected extremities manifested greater internal hip rotation than the unaffected extremities, whereas the latter showed no difference in internal hip rotation compared with normative values. Clinical evaluation of intoeing in children with a history of clubfoot should include a rotational profile to determine the level(s) of deformity and guide therapeutic intervention.