A leading, underestimated cause of disability

Clubfoot is one of the most common birth defects and a major cause of physical disability among children worldwide. In high-income countries, where initial correction routinely happens after birth, clubfoot disability is largely unseen. Many people are surprised to learn how common it is.

Prevalence of talipes equinovarus

One estimate for the global incidence of clubfoot is 1.24 cases per 1,000 live births, or one in about 800 babies.1234 However, this rate likely underestimates the incidence in low-income countries, and no systematic review of global clubfoot incidence that includes data from both high-income and low- and middle-income countries has been published to date, although one metanalysis is underway.5

Based on documented ranges of .6 to 2 per 1,000 births, we conservatively estimate that 200,000 babies are born with the condition worldwide each year. And due to global birth rates, more than 90% percent are born in LMICs where there is little or no access to proper treatment.7

These data imply that as many as 2.4 million children under the age of 18, and 7.5 million people total (all ages) are living with the consequences of untreated or improperly treated clubfoot.8

However, country-level and regional estimates of clubfoot incidence vary widely and have significant limitations. Stigma, a lack of systematic surveillance of and reporting on birth defects and disabilities, inadequate birth registration systems, reliance on hospital-based as opposed to population-based data, and a lack of diagnostic capacity in LMICs can lead to underreporting and inaccuracies in national estimates.9,10,11,12

Recent data suggest that clubfoot is even more common than previously thought. In 1996, the CDC reported 2,226 cases of clubfoot in the US and an incidence rate of 0.6 per 1,000 live births.15,16 However, a broader CDC analysis of data from 5.2 million live births between 2010-2014 determined that 1.69 babies per 1,000 live births (or 1 in 593) are born with clubfoot, making it the most common birth defect in the US.17,18 If estimates from countries with mature birth defect surveillance and reporting systems like the US have underestimated clubfoot’s incidence, countries with weak or absent reporting systems are likely significantly undercounting cases.