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Talipes equinovarus is a deformity of the foot and ankle commonly found at birth (the foot is fully plantar-flexed and there is midtarsal adduction causing a varus deformity). It is estimated to affect 1 in 1000 births in the UK. Boys are twice as likely to be affected as girls.

The cause of the deformity is not completely clear however it is speculated that it is due to mechanical pressure in utero. There also appears to be a genetic link.Diagnosis is usually through clinical observation and x-rays are not routinely required. The Ponseti method is the treatment of choice in the UK and around the world. The foot is manipulated to a near-as-normal position as possible (this is not painful) and a plaster cast is applied to hold it there. This is repeated weekly for a further 6 weeks.

Then at 6 weeks a small operation is performed (under local) called an Achilles tenotomy in which a small cut is made in the tight tendon to allow it to lengthen slightly. The foot then remains in a plaster cast for 3 weeks and the child will need to wear special shoes connected by a bar for 3 months, 23 hours per day. The shoes then need only be worn at night up to the age of 4 years old.
The Ponseti method is successful in 85% of cases. Where it is not, major surgery may be required. Spina bifida is commonly associated with severe club foot.

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