Link Between Clubfoot and Missing Artery

Researchers at SUNY Upstate Medical University say they now have found definitive proof of a link between clubfoot, a congenital deformity, and the absence of major artery in the leg. The study is published in the January issue of the Journal of Pediatric Orthopedics.

The SUNY Upstate study found that 45 percent of the children with clubfoot had missing dorsalis pedis artery, compared with only 8 percent of the children in the study group without clubfoot.

Researchers said the findings are especially important for clinicians who in planning surgeries to correct clubfoot should be cognizant of any arterial abnormalities because of the complications that could arise from vascular compromise to the foot.

The SUNY Upstate study, according to one the researchers, David Hootnick, M.D., clinical professor of medicine at SUNY Upstate and an orthopedic surgeon, provides the most conclusive evidence to date of the link between clubfoot and arterial absence. "The study confirms that arteries were missing in these cases and thus the findings advance the theories for the causation of clubfoot," Hootnick said.

While evidence of a link between clubfoot and arterial absence has been studied for decades, no previous study was conducted with such sensitive technology. What separates this study from others, Hootnick said, is the use of pulsed color-flow Doppler sonography, which gives researchers a significantly more detailed image of vascular anatomy. The pulsed beam is focused to specific depths, allowing detailed interrogation of the region.

Pulsed color-flow Doppler allows determination of the size of the vessel and the direction of blood flow, which is not possible with the continuous-wave Doppler used in earlier studies. Earlier studies using continuous-wave Doppler sonography had shown no evidence of arterial deficiency in children with clubfoot.

"There was not a single study that offered definitive proof of this relationship using continuous-wave Doppler," Hootnick said. "This was confusing since other even earlier studies which relied on anatomic dissection and arteriography had shown up to 86 percent of cases missing dorsalis pedis artery."

In the SUNY Upstate study, researchers went one step further and compared the prevalence of the missing artery in children who had surgery with children who did not undergo surgical treatment. The dorsalis pedis artery was absent in 54 percent of the cases that required surgery compared with 20 percent of the cases that did not. "If one agrees that the more severe clubfeet are, the more likely they require surgery. The data also suggest that deficiency of the dorsalis pedis artery is more likely associated with more severe clubfeet," the study reports.

Researchers studied 25 patients with idiopathic unilateral or bilateral clubfoot and 25 children with no deformity. Children in the study were between the ages of 8.4 and 1.7 months.

Clubfoot affects approximately one in 1,000 newborns. It affects the child's ankle and foot, twisting the heel and toes inward. It is usually correctable with surgery or other medical treatment, such as casting.

The study was conducted at University and Crouse hospitals in Syracuse and funded by the Central New York chapter of the Children's Miracle Network.

Study coauthors include, from SUNY Upstate: Danielle Katz, M.D.; Eileen Albanese, R.N.; David Packard Jr., Ph.D.; Williams Grant, Ed.D; Kenneth A. Mann, Ph.D; Stephen Albanese, M.D; and E. Mark Levinsohn, M.D., from Crouse Hospital.