Treatment of congenital talipes equinovarus (clubfoot)

Abstract

Practically all clubfeet can be completely corrected if proper treatment is begun immediately after birth. Good results, without recurrences, are based upon a gradual reduction of the deformity through a systematic series of manipulations and a period of complete or partial immobilization extending approximately to the weight bearing age, eight months. The manipulative attack must be directed against each of the several components of the deformity if the foot is to be restored to normal. Each of these main components, equinus, adduction-abduction and inversion, must be corrected in both the forefoot and the back foot. In equinus the back foot is plantarflexed at the ankle joint and the forefoot is further plantarflexed on the back foot. In adduction-abduction the forefoot is adducted and the calcaneus is abducted. In inversion both the forefoot and the calcaneus are inverted. Weekly manipulations proceed systematically toward a reduction of each of these component distortions and the gain made with each manipulation is maintained by a plaster-of-Paris cast. The manipulative maneuvers are explained in detail. If good dorsiflexion has not been accomplished within five months the closed operation for achillotomy and posterior capsulotomy is indicated so that the infant may enter the weight bearing period with unhampered feet. For the infants in whom the contracture shows a tendency toward recurrence, elastic extension braces are indicated. These are described.