Related Subjects:
|Developmental Dislocation (Dysplasia) of the Hip (DDH)
|Slipped Upper Femoral Epiphysis (SUFE)
|Perthes disease (Osteochondritis of the Hip)
|Congenital Talipes Equinovarus - Clubfoot
👣 Clubfoot / Congenital Talipes Equinovarus (CTEV) — the foot points down and in.
Common at birth, correctable if treated early.
📖 About
- Clubfoot (CTEV) is a congenital condition where the lower leg, ankle, and foot are twisted inward and downward.
- Usually present from early pregnancy and visible at birth.
- One of the most common congenital musculoskeletal deformities.
📌 Risks
- 👦 Boys > 👧 Girls.
- Bilateral in 25–50% of cases.
- Positive family history may increase risk.
🔗 Associated Conditions
- Spina bifida.
- Cerebral palsy.
- Arthrogryposis.
- Other neuromuscular disorders.
🩺 Clinical Features
- At birth: the foot points down and inward (equinovarus position).
- Tight Achilles tendon at the heel.
- Shortened medial tendons (inside of leg).
- Rigid deformity (not correctable to neutral position by gentle manipulation).
🔍 Investigations
- 👶 Antenatal USS: may detect CTEV during pregnancy.
- Diagnosis is usually clinical at birth.
🩹 Management
- Ponseti Method (gold standard):
- Gentle manipulation of the foot with weekly above-knee plaster casts.
- Started ideally in the first week–10 days of life.
- Corrects deformity step by step (cavus → adductus → varus → equinus).
- Achilles tenotomy: often required to lengthen a tight tendon.
- Done under local anaesthetic.
- Baby usually goes home the same day.
- 3 weeks of casting afterwards to maintain correction.
- Boots-on-bar orthosis:
- Open-toe sandals attached to a bar, feet held in external rotation.
- Full-time for 3 months → then at night until ~5 years old.
- Essential to prevent relapse.
- 🧑⚕️ Regular follow-up with physiotherapy and orthopaedics to monitor growth, recurrence, and function.
💡 Teaching Pearls
- 🧠 Remember: “CAVE” for deformity components:
Cavus, Adductus, Varus, Equinus.
- ✅ Early casting → best outcomes.
- ❌ Do not confuse with positional talipes (flexible, corrects with passive movement).
- 👣 Relapse is common without prolonged bracing.
📚 References
- Ponseti IV. Congenital Clubfoot: Fundamentals of Treatment. Oxford University Press, 1996.
- NICE Clinical Knowledge Summaries: Clubfoot (Talipes)
