What causes complex clubfoot?
In the normal clubfoot, the main deformity is the in-turning of the heel (adduction). This is not a big problem in the atypical clubfoot. In an atypical clubfoot the main parts of the deformity are the severely short Achilles tendon (equinus) and general toe-down position of the foot (plantarflexion) and the “scrunching up” of the midfoot causing an extremely high arch (cavus or plantaris). The ankle bone (talus) is tilted down and forward severely almost to the point of dislocation under the shin bone (tibia). The toe-down tilt is unyielding. All of this is thought to be caused by a tightening and shortening of the ligaments in the ankle/heel area and the sole of the foot (the posterior hindfoot and plantar facia respectively). All clubfeet have tendons, ligaments and muscles effected by shortening and tightening, however these ligaments are usually not involved, or at least not to the same extent that they are in an atypical clubfoot. The long toe flexors, which are the muscles that
