CLUBFOOT DEFORMITY IN DOWNS-SYNDROME

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.