/congenital-talipes-equinovarus-club-foot Congenital Talipes Equinovarus (Club Foot)
 
Medicine

Congenital Talipes Equinovarus (Club Foot)

Concise overview and treatment of Congenital Talipes Equinovarus (Club Foot)
 

It is a congenital foot deformity. (Equine = horse, varus = distal end deviated medially.)
Muscle contractures result in a CAVE deformity:

CAVE deformity:

  • C - Midfoot Cavus
  • A - forefoot Adductus
  • V - hindfoot Varus
  • E - hindfoot Equinus

Cavus (pes cavus) = High arched foot
Equinus = Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet.

The bony deformities are:

  • talar neck medial and plantar deviated
  • varus calcaneus and rotated medially around talus
  • navicular and cuboid medially displaced

Affects 1-2 out of every 1000 newborns, 50% of them occur bilaterally with it more common in males. But female severity is greater.

Etiology

Intrinsic vs Extrinsic

Intrinsic causes include:

  • Neurological
  • Muscular
  • Connective Tissue

Extrinsic:

  • Intrauterine growth restriction

It may also be neurogenic, idiopathic or syndrome associated.

Physical Exam

  • Examine hips for DPH
  • Examine knees for deformity
  • Examine back for dysraphyism (unfused vertebral bones)

Treatment

Mostly non surgical via the Ponseti Technique (Serial manipulation and casting)
You must correct the deformities in CAVE order mentioned above.

Change the strapping/cast q1-2 weeks. Surgery only indicated in refractory cases, but delay until 3-4months. Recurs in about 5-10% of cases in 3 years but mild recurrence common, and the affected foot is permanently smaller and stiffer than normal foot due to calf atrophy.