Research Article: Congenital talipes equinovarus: an epidemiological study in Sicily

Date Published: June 4, 2012

Publisher: Informa Healthcare

Author(s): Vito Pavone, Sebastiano Bianca, Giuseppe Grosso, Piero Pavone, Antonio Mistretta, Maria Roberta Longo, Silvia Marino, Giuseppe Sessa.


Congenital talipes equinovarus (clubfoot) can present in 2 forms: “syndromic”, in which other malformations exist, and the more common “idiopathic” form, where there are no other associated malformations. We analyzed the epidemiology of congenital talipes equinovarus in the Sicilian population, looking for potential etiological factors.

Among the 801,324 live births recorded between January 1991 and December 2004, 827 cases were registered (560 males; M/F sex ratio: 2.1). Control infants were randomly selected from a historical cohort of live births without any major congenital malformations.

A positive family history of clubfoot, gender, and maternal smoking were found to be risk factors for clubfoot. Patients with clubfoot were born most frequently during the period January–March. No association was found between clubfoot and reproductive history, peri-conceptional maternal drug exposure, maternal education, or ethnicity.

Our findings emphasize the importance of birth defects surveillance programs and their usefulness in investigating potential risk factors.

Partial Text

Between January 1991 and December 2004, 827 cases (560 males, sex ratio 2.1) were recorded. Among the 801,324 newborns recorded in Sicily between 1991 and December 2004, the birth prevalence of children affected by clubfoot was 1.03 per 1,000 births (Table 1). The anomaly was bilateral in 529 cases (64%) and unilateral in 298 cases (36%)—55% of these on the right side. We also determined whether the distribution of patients with left or right side affected or bilateral clubfoot was similar in boys and girls. No sex-related side difference could be detected (p = 0.8) and the proportion of bilateral clubfoot was similar in boys and girls (64%) (p = 0.9) (Table 2).

We found a cumulative incidence of congenital clubfoot in Sicily during the period 1991–2004 that was similar to that reported for Italy (unpublished data). We also found a decrease in the cumulative incidence during the last years of the observation period. However, we cannot assess whether this is because of under-reporting. Although it is difficult to provide a definite answer, we consider our study to be important because it is one of the few studies to investigate cumulative incidence and prevalence of clubfoot with assessment of possible risk factors.