Clubfoot or Talipes Equinovarus is a deformity where the foot turns inwards due to the contracture of the musculature and soft tissue on the medial aspect of the foot. This can be bad enough where the foot is facing sideways and upwards. 1 in every 1000 births shows the presence of clubfoot. This is one of the most common congenital foot deformities. Prognosis is excellent for infants that receive early intervention. However, if left untreated can lead to permanent deformity, disability, pain and gait impairment.
Clubfoot
Cause:
Genetics: Certain genes (PITX1) show a high prevalence for the development of clubfoot.
Increased intrauterine positioning and pressure
Idiopathic
Symptoms:
C.A.V.E- Cavus, Adductus, Varus, Equinus
Talar neck is medially and plantarly deviated
Walking on the outside of the foot
Shortened Tibia
Weak calf musculature
Pain with ambulations
Limitation with range of motion of the foot and ankle joints
Treatment:
X-rays, MRI, CT may be performed to visualize the bone pathology
Conservative:
Most cases of clubfoot can be treated with serial casting. The ponseti casting technique is the gold standard for initial clubfoot treatment. After the casting the patient will have a release of the achilles tendon performed. There is a 90 percent success rate with casting if done right. Patient will then be placed in a forefoot abduction brace. This brace holds the foot in external rotation and dorsiflexion and must be worn for 23 hours a day for the 1st 3 months.
Surgical:
In rare cases that conservative therapy has failed multiple times or there is still residual deformity present after serial casting then surgical intervention is warranted. Surgical procedures include Posterior medial release, Tendon transfer, Medial column lengthening, Talectomy, Supramalleolar osteotomy, External fixator assisted correction and Triple arthrodesis. The correct procedure will be determined by the surgeon.
