Background

Clubfoot, or talipes equinovarus, is a congenital condition that occurs when the foot is twisted inward and downward due to shortened leg tendons. Clubfoot typically occurs alone and can affect either one or both feet. Males are twice as likely as females to have clubfoot and are more likely to have bilateral clubfeet. [1] An individual with clubfoot can be diagnosed prenatally by ultrasound, or postnatally by physical exam or through x-rays and imaging studies. [2] The severity of this condition varies by individual. In some cases, the foot is flexible and can be moved passively to a normal (or near-normal) position. In most cases, the foot is rigid and stiff and cannot be manually manipulated. [2] To avoid complications of this condition, treatment often begins right after birth. Depending on the severity of the condition, treatment can consist of: serial casting, manual stretching and manipulation, or surgery. [1]

The cause of clubfoot is unknown. A combination of genetics and environmental factors may contribute to the condition. [1] Although clubfoot does not cause a newborn any pain, walking with clubfoot can be very painful, and sometimes impossible.

Epidemiology

Alaska Birth Defects Registry (ABDR) registers birth defects as reported from health care providers using International Classification of Disease (ICD) billing codes. The use of these ICD codes can lead to misclassification of diagnosed conditions. Prior to this report, all prevalence estimates were based on the number of unique children reported to ABDR with an ICD code representing a specified condition regardless of case confirmation status.

The estimates in this report were derived by conducting medical record review and case confirmation of a random sample of cases of the condition reported to ABDR. The confirmation probability from the sample was used to develop informed estimates of the actual diagnosed defect prevalence. See Defect prevalence calculation.

For explanations of table columns see Column descriptions.

Prevalence

Clubfoot is a common congenital birth defect, occurring in approximately 16.87 (95% CI 16.46–17.30) out of every 10,000 live births in the United States. [3]

In Alaska, during 2007-2021, the prevalence of club foot was 10 per 10,000 live births.
Reports Defects Births Prevalence (95% CI)
532 163.2 162989 10.0 (8.6, 11.7)
Notes: 95% CI = 95% Confidence Interval

Trend

Prevalence per 10,000 births of club foot during 2007-2021 by five-year moving averages, with 95% confidence interval band and Poisson estimated fitted line.
The p-value test for trend detected a significant decrease in the number of live births with club foot during 2007-2021. See p-value estimate
Estimate Std. Error t value Pr(>|t|)
-0.03130 0.00305 -10.26906 0.00000
Notes: 95% CI = 95% Confidence Interval

Regional Distribution

Distribution of club foot in Alaska by Public Health Region of maternal residence at the time of birth. A description of regional breakdowns can be found here. Data suppressed for # of reports < 6.

Demographics

Some subgroups may be more at risk for having a baby with club foot. This section provides the descriptive epidemiology of specified maternal, birth, and child characteristics identified from the birth certificate.

Accompanying Diagnoses

The ten diagnoses most commonalty associated with club foot.

Technical notes

Column descriptions

# Reports: Unless otherwise noted, the number of unique reports of the defect received by ABDR during the specified birth year(s). Each report represents a unique child with the specified defect.

# Defects: The estimated true number of reports that are diagnosed defects based on medical record review and case confirmation.

# Births: The number of live births among Alaskan residents that occurred in Alaska during the specified birth year(s).

Prevalence (95% CI): The estimated diagnosed prevalence of the condition and corresponding 95% Confidence Interval. (For information on how the defect prevalence was estimated see below).

Defect prevalence calculation

The estimated defect prevalence was calculated using a Bayesian approach based on the reported prevalence, PPV and 1-NPV (see formula below).

Through medical records review and case confirmation of a random sample of reported cases, the defect prevalence is calculated as:

\[PPV (Positive Predictive Value) = p(defect|report)\] \[NPV (Negative Predictive Value) = p(\overline{defect}|\overline{report})\]

\[p(defect) \approx [p(report)\cdot PPV]+[p(\overline{report})\cdot (1-NPV)]\]

Defect prevalence estimates are a more accurate estimation of the actual diagnosed prevalance of birth defects compared to the reported prevalance estimates in Alaska. ABDR obtains reports from medical providers using International Classification of Disease (ICD) codes that are extracted from individual systems which when aggregated may not reflect true diagnostics. Caution should be used when interpreting and comparing the reported prevalence estimates with national estimates.

See Data analysis methods for more information.

P-value estimate

To evaluate the trend over time and account for under/over-dispersion we constructed a quasi-Poisson regression model. This model assumes the variance is a linear function of the mean and models the estimated number of annual defects by year with a natural log (ln) offset of the annual births. P-values < 0.05 are considered significant, which indicates that the predicted slope is significantly different from a slope of zero.

Data suppression

For region and demographic data tables, values are suppressed based on the number of reports received during the observation period. Counts less than 6 are suppressed (as indicated by ‘-’ in the table). For regions or demographics with only one cell count suppressed a second is suppressed to eliminate the ability to back-calculate the estimate.

References

[1] Clubfoot - OrthoInfo - AAOS. (2020). Retrieved 23 December 2020, from https://orthoinfo.aaos.org/en/diseases--conditions/clubfoot/

[2] National Birth Defects Prevention Network Appendix 3.1 Birth Defects Descriptions for NBDPN Core, Recommended, and Extended Conditions Updated March 2015. (2020). Retrieved 23 December 2020, from https://www.nbdpn.org/docs/Appendix_3_1_BirthDefectsDescriptions2015_2016DEC14.pdf

[3] Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle‐Colarusso T, Cho SJ, Aggarwal D, Kirby RS. National population‐based estimates for major birth defects, 2010–2014. Birth Defects Research. 2019; 111(18): 1420-1435

Authorship

Maternal and Child Health (MCH) senior epidemiologist Dr. Jared Parrish, PhD conceived of the presented analysis. Alaska Birth Defects Registry program manager and epidemiologist Chris Barnett, MS MPH and Dr. Jared Parrish, PhD developed the theory and performed the computations. Research analysts Monica Mills and Jordyn Lord managed data collection and storage. All authors discussed the results and contributed to the final report.

Suggested Citation

State of Alaska Department of Health and Social Services, Division of Public Health, Section of Women’s, Children’s, and Family Health. Alaska Birth Defects Registry Condition Report: Club Foot, Alaska, 2007-2021. Updated April 11, 2024. Available at: http://rpubs.com/AK_ABDR/ClubFoot.

Contact

Alaska Birth Defects Registry (ABDR)
3601 C Street, Suite 358
Anchorage, AK 99503
(907) 269-3400 phone
(907) 754-3529 fax

Updated: April 11, 2024
Code source: R:\ABDR\Analysis_New\ABDR_CASECONF\cond_reports\Published_reports\Targets_publications\club_foot_tar.Rmd