The association of Down's syndrome (trisomy 21) with clubfeet has not
previously been elaborated, Eight patients with a total of 15 clubfeet
were identified for review Five of these had trisomy 21 noted by chro
mosomal analysis, and 1 had a mosaic pattern, Two patients did not hav
e chromosomal documentation, but had characteristic features of Down's
syndrome, Interestingly, 2 patients had evidence of arthrogryposis as
well as Down's syndrome, Four of the 8 patients had other orthopedic
anomalies, including scoliosis, atlantoaxial instability, brachydactyl
y, and coxa valga, All 8 patients had an initial period of casting pri
or to any surgical intervention, Fourteen of the 15 feet required surg
ical intervention to afford correction of the deformity, The 6 feet wi
th relatively long-term follow up (average: 5 years) showed that there
was 1 excellent, 4 good, and 1 fair result using the criteria of Turc
o. It appears that, even though Down's syndrome is usually characteriz
ed by ligamentous laxity, when clubfeet are associated with this syndr
ome they are often resistant to nonoperative treatment, and surgical t
reatment seems to produce an acceptable result.