Clubfoot (talipes equinovarus)

• Toe-in deformity presenting at birth. Also see Intoeing
• one of the most common congenital anomalies
• equal frequency of b/l vs unilateral.
• caucasians: M>F, 1/1000 live births; highest in Polynesians 6.8/1000 and South African blacks 3.5 / 1000; least likely: asians
• may also be due to intrauterine environment

Presentation

• forefoot: adducted and sometimes supinated; cannot usually be abducted to the neutral position passively
• hindfoot: fixed inversion (varus) and plantar flexion of ankle causes foot/toes to point down (equinus); cannot be everted or dorsiflexed past the neutral position.
• very severe medial mid-foot crease usually with a very small heel.
• If unilateral (R>L): foot is smaller, ankle/foot joints thick/contracted, inhibiting fn

Differential diagnosis

• If ankle can be dorsiflexed to neutral or beyond, consider Metatarsus adductus in ddx.
• Consider neurologic imbalance (myelodysplasia, spinal cord tethering), or degenerative neuro conditions.
• Be sure to evaluate the back for any physical findings because of the possibility of spinal dysraphism.
• Bilateral deformities have been associated with muscle disorders such as spinal muscular atrophy and congenitalmyopathies.
• syndrome associations: arthrogryposis, congenital dislocation of hips, caudal regression syndrome, CP, craniocarpotarsal dystrophy, diastrophic dwarfism, larsen syndrome, meningomyelocele, progressive spinal atrophy (peroneal type), spinal cord tumor, myotonic dystrophy

What to do

• Ped ortho consult on day of birth
• TX: early tx: manipulation, serial casting/cast wedging with progressive correction; if child seen late, or closed tx unsuccessful: open reduction and surgical release of the contracted soft tissues. Do all this before pt is walking to preserve normal development.
• EARLY Rx with serial casting corrects the deformity in 80%;

Talipes

CHLA Board Review 2005