Clubfoot was diagnosed between 12 and 23 weeks of gestation in 86% of children and between 24 and 32 weeks of gestation in the remaining 14%.Without treatment the foot remains deformed and people walk on the sides or tops of their feet, which can cause calluses, foot infections, trouble fitting into shoes, pain, difficulty walking, and disability. Causes
Hypotheses about the precise cause of clubfoot vary. However, research has found that genetics, environmental factors or a combination of both are associated with this condition. Evidence suggests that the etiology of clubfoot is most likely multifactorial. A meta-analysis and systematic review found that the most clinically relevant risk factors for clubfoot were family history, paternal and maternal smoking, birthing parent obesity, gestational diabetes, amniocentesis, and the use of selective serotonin re-uptake inhibitors (SSRIS). Many findings agree that "it is likely there is more than one different cause and at least in some cases the phenotype may occur as a result of a threshold effect of different factors acting together." The most commonly associated conditions are distal arthrogryposis or myelomeningocele. The factors contributing to the development of clubfoot can be categorized as extrinsic and intrinsic factors.Extrinsic Factors
Factors that can influence the positioning of the fetal foot in uteru include oligohydramnios, breech presentation, Müllerian anomalies, multiple gestation, amniotic band sequence, or amniocentesis at <15 weeks of gestation. In cases that impede normal growth and position for longstanding period of times, clubfoot can be accompanied with other deformations and may be associated with developmental hip dysplasia.
Keratolysis exfoliativa (also known as "lamellar dyshidrosis", "recurrent focal palmar peeling", "recurrent palmar peeling": 212 ) is a sometimes harmless, sometimes painful skin condition that can affect the focal surface of the fingers and/or the palm or soles of the feet. It is often misdiagnosed as chronic contact dermatitis or psoriasis. It is characterized by dry skin and superficial, air-filled blisters. These blisters can be peeled off very easily and will leave reddish, tender areas. The loss of this corneal layer of the skin, which protects the underlying layers, leaves the skin more vulnerable to dryness and cracking. Causes
Keratolysis exfoliativa normally appears during warm weather. Due to excessive sweating and friction, in for example athletic shoes, the skin can start to exfoliate. Other factors that can cause exfoliation are detergents and solvents. Another very common cause has been reported from salt water fishermen, who often suffer from these symptoms. It is not sure whether it is from the salt water or whether it is from some bacteria from fish. Treatment
Normally, exfoliation is restricted to a particular area and normal skin will replace the exfoliated parts, so no treatment is needed. Since keratolysis exfoliativa is caused by friction, detergents, and solvents, these factors should be avoided. Creams, especially those with silicone and lactic acid are also helpful. In severe cases, photochemotherapy is an option. Prognosis
In most cases exfoliation resolves spontaneously and no lasting damage is seen. However, some patients experience cracking and even bleeding in extreme cases. See also
Acrokeratoelastoidosis of Costa
Peeling skin syndrome
List of cutaneous conditions

References
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