Talipes equinovarus

Talipes equinovarus, or club foot, describes an inverted (inward turning) and plantar flexed foot. It is usually diagnosed on the newborn exam.

Talipes equinovarus is twice as common in males than females and has an incidence of 1 per 1,000 births. Around 50% of cases are bilateral.

Most commonly idiopathic. Associations include:

• spina bifida
• cerebral palsy
• Edward's syndrome (trisomy 18)
• oligohydramnios
• arthrogryposis

The diagnosis is clinical (the deformity is not passively correctable) and imaging is not normally needed.

Management*

• in recent years there has been a move away from surgical intervention to more conservative methods such as the Ponseti method
• the Ponseti method consists of manipulation and progressive casting which starts soon after birth. The deformity is usually corrected after 6-10 weeks. An Achilles tenotomy is required in around 85% of cases but this can usually be done under local anaesthetic
• night-time braces should be applied until the child is aged 4 years. The relapse rate is 15%
• reference: BMJ 2010; 340:c355: Current management of clubfoot. Bridgens J, Kiely N