Congenital talipes equinovarus (clubfoot)

Abstract

Congenital talipes equinovarus (‘clubfoot’) refers to foot deformity characterized by equinus of the hindfoot, adductus and varus of the mid-foot and a high arch (cavus). The annual incidence in the UK is about 1 per 1000 live births; the condition is bilateral in 50% of cases and there is a male preponderance (3:1). There is a polygenic inheritance for sensitivity to unknown environmental factors. Most ‘fixed’ clubfeet are idiopathic, but clubfoot can be associated with a number of syndromes (e.g. arthrogryposis, Larson’s, Downs). Underlying neurological causes must be excluded, particularly in stiff bilateral clubfeet. The aim of management is to correct the deformity early and fully, and maintain correction with growth until skeletal maturity; this should result in a flexible, pain-free plantigrade foot. The trend towards surgical management has reversed during the past decade, with the Ponseti method of serial casting followed by bracing the first-line management in the newly diagnosed clubfoot. Most feet treated by this method (95%) achieve an excellent result. Surgery tends to be reserved for recurrent deformity (posteromedial release, Ilizarov method, reconstructive surgery) or as a salvage procedure (hindfoot fusion).