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:
- 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.
Intrinsic vs Extrinsic
Intrinsic causes include:
- Connective Tissue
- Intrauterine growth restriction
It may also be neurogenic, idiopathic or syndrome associated.
- Examine hips for DPH
- Examine knees for deformity
- Examine back for dysraphyism (unfused vertebral bones)
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.