Club Foot (Talipes Equinovarus)

What is Club Foot?

Club foot is a congenital deformity, i.e. a condition present at birth, where one or both feet abnormally point inward and downward.

In most cases, early treatment can help in complete correction of the deformity.

Club foot is also known as:

talipes equinovarus (TEV) or
congenital talipes equinovarus (CTEV).

In 50% of the cases, both feet are affected.

Who does Club Foot Affect?

The condition occurs in about 1 in every 1000 live births, with certain countries having an even higher incidence.

Club foot is more frequent in boys than girls by a ratio of 2:1.

Club foot in adults occurs as a recurrence or residual deformity of infant club foot.

How does Club Foot Occur?

The actual pathophysiology of club foot is still unclear, however, it is suspected that one or more of the following processes play a role in the development of club foot:

Neurogenic factors,
Congenital issues, resulting in the arrest of fetal development,
Defective bone formation,
Retracting fibrosis, and
Improper tendon insertions.

These factors result in the tendons connecting the leg musculature to the foot to become taut and short, resulting in the foot to rotate inwards.

Causes of Club Foot

The exact cause of club foot is not known, however, it is considered that a genetic predisposition may play a role in its development.

Symptoms of Club Foot

Club foot can be mild or severe and have symptoms such as:

Foot slightly smaller than the normal
Front of the foot twisted toward the other foot
Foot turned inward and downward.

Types of Club Foot

Adult club foot may be present in two forms:

Postural or positional: The foot is flexible and can be moved to the normal position after birth.
Rigid or fixed: The foot is rigid or stiff or fixed and the muscles at the back of the leg are very tight.

How is Club Foot Diagnosed?

The diagnosis of club foot is usually done after birth. However, an experienced ultrasonographer can detect it during a routine ultrasound scan done during 18 – 21 weeks of pregnancy.

How is Club Foot Treated?

Treating club foot involves explaining the condition to the parents and then performing physiotherapy for the baby.

Conservative Treatment

In most cases, there is no treatment needed as the feet will correct themselves within twelve weeks. The babies should be regularly monitored, and if there is no improvement, these babies may need physiotherapy.

Ponseti Method

For babies requiring therapy, a method known as ‘Ponseti’ method’ is used to put the baby’s foot in a better position, then using a cast to keep it stable. A minor operation to loosen the Achilles tendon may also be required. This surgery is done under local anesthesia. The use of special boots is also required to keep the club foot from returning.

Adult Club Foot Treatment

Adult club foot may be treated through conservative approaches such as stretching and casting, or surgical procedures such as osteotomy, fusion or arthrodesis.

What if Club Foot is Untreated?

If left untreated, club foot won’t improve on its own.

The child will be forced to walk unnaturally on the outer edge of their feet instead of the sole of the foot, resulting in pain, calluses and severely limited activity.

They will be unable to wear shoes and have lifelong pain.