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Club foot (talipes equinovarus) (Epidemiology (M=F, 50% bilateral,…
Club foot
(talipes equinovarus)
Definition
Congenital disorder of
the foot
Epidemiology
M=F
50% bilateral
Positional talipes is common
Pathophysiology
Defect
Sometimes congenital disorders (e.g. NTDs), usually biomechanical factors in utero (i.e. intrauterine compression)
Vertical talus (stiff, rocker bottom soles) is similar but more commonly due to congenital disorders
Talipes calcaneovalgus is also similar (dorsiflexion and eversion) from similar mechanism
Mechanism
Inversion and adduction of foot and plantarflexion
Short affected foot, thin calf muscles
If positional talipes, it can be passively moved back into position; if talipes equinovarus, it is a fixed deformity
Clinical presentation
Limp
May have delayed
walking
Foot deformity
Diagnosis
Examination
Ankle/foot exam
Visible pes cavus adduction, varus, equinus
reduced eversion and dorsiflexion
If passively correctable, positional; if not, equinovarus
History
PMH
Growth and development
Known medical conditions
POH
Scans, bloods, gestation,
delivery, weight, complications
PC/HPC
Deformity of foot, limping
on walking, delayed walking
DH
Meds, allergies
FH
Talipes, other musculoskeletal disorders
SH
Living arrangements, nursery/school
Management
Conservative
Information, advice, support
Physiotherapy (passive foot manipulation)
Surgery
Soft tissue release
Indication: 2L equinovarus if casting failure
MOA: soft tissue reconstruction, Achilles tendon lengthening
Bony surgery
Indication: later childhood if prior
measures unsuccessful
Ponsetti casting
Indication: 1L talipes equinovirus ASAP from birth
