Is there evidence for aetiologically distinct subgroups of idiopathic congenital talipes equinovarus? A case-only study and pedigree analysis.

Cardy, Amanda H.; Sharp, Linda; Torrance, Nicola; Hennekam, Raoul C.; Miedzybrodzka, Zosia

Abstract

Idiopathic congenital talipes equinovarus (CTEV) is a common developmental foot disorder, the aetiology of which remains largely unknown. Some aspects of the epidemiology suggest the possibility of aetiologically distinct subgroups. Previous studies consider CTEV as a homogenous entity, which may conceal risk factors in particular subgroups. We investigate evidence for aetiologically distinct subgroups of CTEV. Parents of 785 probands completed a postal questionnaire. Family pedigrees were compiled by telephone. Case-only analysis was used to investigate interactions between risk factors and sex of the proband, CTEV laterality and CTEV family history. The male:female ratio was 2.3:1, 58% of probands were affected bilaterally and 11% had a first-second degree family history. There were modest interactions between family history and twin births (multivariate case - only odds ratio [ORca]=3.87, 95%CI 1.19–12.62); family history and maternal use of folic acid supplements in early pregnancy (ORca=0.62, 95%CI 0.38–1.01); and between sex of the proband and maternal alcohol consumption during pregnancy (female, positive history and alcohol consumed: ORca=0.33, 95%CI 0.12–0.89). Previous reports of an interaction between maternal smoking and family history were not confirmed. Relatives of female probands were affected more often than relatives of male probands. These results provide tentative evidence for aetiologically distinct CTEV subgroups. They support the "Carter effect", suggesting CTEV develops though a multifactorial threshold model with females requiring a higher risk factor "load", and suggest areas where future aetiological investigation might focus. Large multi-centre studies are needed to further advance understanding of this common condition.

Citation

CARDY, A.H., SHARP, L., TORRANCE, N., HENNEKAM, R.C. and MIEDZYBRODZKA, Z. 2011. Is there evidence for aetiologically distinct subgroups of idiopathic congenital talipes equinovarus? A case-only study and pedigree analysis. PLOS one [online], 6(4), article number e17895. Available from: https://doi.org/10.1371/journal.pone.0017895

• Journal Article Type: Article
• Acceptance Date: Feb 14, 2011
• Online Publication Date: Apr 20, 2011
• Publication Date: Apr 30, 2011
• Deposit Date: Sep 22, 2023
• Publicly Available Date: Sep 22, 2023
• Journal: PLoS One
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 6
• Issue: 4
• Article Number: e17895
• DOI: https://doi.org/10.1371/journal.pone.0017895
• Keywords: Congenital talipes equinovarus (clubfoot)
• Public URL: https://rgu-repository.worktribe.com/output/819893