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.
- Parents with a baby with clubfoot have a 1 in 30 chance of subsequent babies being born with club foot
- Smoking during pregnancy increases the risk of clubfoot
It can be anywhere form mild to severe and can affect one or both feet. It is associated with an underdeveloped calf muscle and a short achilles tendon. The bones, ligaments, tendons and muscles in the foot are all affected and are underdeveloped.
- If left untreated the deformity can become permanent and can affect the child’s ability to walk
- Adults who were not successfully treated as children often have an altered gait, which can cause localised foot issues (such as ulceration and pain) and which can also affect other joints – especially the hips – causing chronic hip pain and early onset of osteoarthritis
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 anaesthetic) called an Achilles tenotomy in which a small cut is made in the tight achilles 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 (a foot abduction brace – see below) 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 successful, major surgery may be required. Spina bifida is commonly associated with severe club foot.
- In those children with a good recovery there is essentially normal long-term functioning of the foot
- In unilateral cases, the affected foot and calf will typically always be smaller than the unaffected side
- Occasionally club foot can return. In these cases, special footwear or bracing can be used again to improve the anatomy and function of the foot
References
- Clubfoot (talipes equinovarus) – Royal Children’s Hospital
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
- Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy