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Talipes Equinovarus (Club foot)

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Overview

Also known as clubfoot, talipes equinovarus describes the inward turning (varus) and plantarflexion of the foot. ‘Tali’ means ankle, ‘pes’ means foot, and ‘equinus’ means pointing down, similar to how a horse’s (equine) foot points down, and ‘varus’ means inwards turning.

Talipes equinovarus is often present at birth and can be described as:

  • Positional talipes equinovarus – a normal foot that has been held in equinovarus in the uterus:
    • This is generally correctable with gentle, passive dorsiflexion of the foot and is around 5 times more common than congenital talipes equinovarus.
  • Congenital talipes equinovarus:
    • This is fixed and may be idiopathic or due to abnormal development

Epidemiology

  • Talipes equinovarus occurs in around 1 in 1000 births
  • Talipes equinovarus is around 2 times more common in boys than girls
  • Around 50% of cases affect both feet

Associations

Overview

Although most cases are idiopathic, talipes equinovarus is associated with:

  • Foetal restriction in utero may lead to positional talipes equinovarus – oligohydramnios
  • Neuromuscular disorders – cerebral palsy, spina bifida
  • Genetic conditions – Edwards’s syndrome and DiGeorge syndrome

Diagnosis

Overview

Congenital talipes equinovarus is diagnosed clinically when the deformity is not passively correctable. In some cases, X-rays and ultrasound scans may be used to assess severity and monitor treatment.

Management

Overview

Talipes equinovarus is treated non-surgically if identified at or soon during birth.

The Ponseti method is often used which involves progressive repositioning by re-casting weekly for a few months. Near the end of treatment, an Achilles tenotomy is also performed to lengthen the Achilles tendon.

Surgery may be considered in cases where there is a fixed deformity leading to more significant problems that cannot be managed non-surgically. 

Complications

  • Disability if untreated
  • Recurrence – more likely with poor adherence to treatment

Prognosis

  • Non-surgical treatment in idiopathic talipes equinovarus has a correction rate of up to 90%

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