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
- A.Equinus
- B.Calcaneus
- C.Valgus
- D.Varus
- E.Cavus

CHLA Board Review 2005