Understanding Clubfoot: Integrating Historical Origins, Embryologic Foundations, Epidemiology and Etiology—A Review

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PURPOSE: Congenital talipes equinovarus (CTEV) or idiopathic clubfoot, is a common yet complex congenital musculoskeletal deformity characterized by cavus, adductus, varus and equinus components. Despite advances in conservative and surgical management, recurrence and long-term functional limitations remain unresolved challenges. This review aims to provide an integrative synthesis of the historical evolution, embryological basis, etiological theories and clinical implications of idiopathic clubfoot. METHODS: A narrative literature review was conducted, synthesizing data from historical records, embryological studies, genetic and developmental biology research and clinical reports. Key theories of etiology, including embryological, genetic, vascular, neuromuscular, environmental and structural mechanisms, were critically examined to highlight converging and divergent perspectives. RESULTS: The evidence suggests that idiopathic clubfoot arises from a multifactorial interplay of genetic predisposition, aberrant embryological signaling pathways, vascular dysgenesis, and environmental influences. While molecular studies implicate PITX1-TBX4 pathways and extracellular matrix remodeling, developmental hypotheses highlight disruptions in muscle patterning, connective tissue organization and vascular development. Clinically, even well-corrected cases demonstrate persistent sequelae such as restricted ankle mobility, muscle weakness and altered biomechanics, predisposing to early degenerative joint changes. CONCLUSIONS: CTEV should be considered a systemic developmental dysplasia rather than an isolated foot deformity. The persistence of recurrence and long-term morbidity underscores the need for multidisciplinary research integrating genetics, developmental biology, biomechanics and rehabilitation. Improved understanding of the etiological mechanisms may enable earlier detection, targeted interventions and ultimately better long-term outcomes for affected individuals.

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