A histochemical study of muscle in club foot

Abstract

A histochemical analysis was made of 103 muscle biopsies taken from 62 patients with idiopathic club feet. Any reduction in the diameter of the muscle fibres associated with wasting of the calf muscle was recorded. Histochemical abnormalities existing in these biopsies were revealed by comparison with normal biopsies obtained from the normal legs of 13 children with unilateral deformities. No significant difference was found between the diameter of the muscle fibres taken from normal and affected legs aged under six months. This indicates that wasting of the calf muscle is due to a reduction in the number of fibres rather than their size. The muscle structure was normal excluding denervation and reinnervation. The soleus muscle in patients aged under six months contained 61 per cent Type 1 fibres in the affected legs, compared to 44.3 per cent in normal legs. Similar values were found in the normal and abnormal tibialis posterior muscles, long flexors of the toe and peroneal muscles. The change in composition of the soleus muscle and the reduction in the number of fibres may be caused by a defective neural influence on the development of the limb in club foot.

Leg muscle atrophy in idiopathic congenital clubfoot: Is it primitive or acquired?

“…On the other hand, this hypothesis has been ruled out by several studies performed on biopsy specimens of patients with CCF, where the only recurrent microscopic finding was a relative increase of type I fibers in the musculature of the affected leg [21][22][23][24][25][26][27]. Therefore, according to Gray and Katz [22], wasting of leg musculature in CCF can only be due to a reduction in the number of muscle fibers. Bechtol and Mossman [1] and Flinchum [2] first suggested the hypothesis that foot deformity in CCF might be caused by the ''failure of muscle growth to keep pace with bone growth.''…”

Tibialis Anterior Tendon Transfer after Clubfoot Surgery

“…Recent biopsy studies of the extrinsic muscles of the calf during clubfoot surgery have demonstrated fiber type disproportion, reduction in the number of muscle fibers, increased neuromuscular junctions, and electron microscopic abnormalities [22,24,33]. The normal ratio of type I to type II fibers is 1:2 but in clubfeet the relationship is approximately 7:1.…”

Evaluation of outcome of treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting

“…Boys are affected 2.5 times as often as girls, and the condition is bilateral in half of the cases. With etiology still unknown, several theories were proposed to explain the origin of clubfoot, considering intrinsic or extrinsic causes, including: intrauterine position of the fetus, mechanical compression or increase of intrauterine hydraulic pressure [3] ; interruption in fetal development [4] ; viral infections [5] ; vascular deficiencies [6] ; muscular alterations [7] ; neurological alterations [8] ; defect in the development of bones structures [9] and genetic defects [10] . However, it seems that clubfoot is considered a multifactorial disease [1] .…”