CLUB FOOT (CONGENITAL TALIPES EQUINOVARUS)

INTRODUCTION

Clubfoot is a congenital foot condition, which affects approximately 1 out of every 1000 births in the United Kingdom. However, prevalence of this condition is twice as common in males than females. The deformity can be mild or severe and it can affect one foot or both feet. As many as 50% of cases are bilateral (both feet are affected). Club Foot is sometimes confused with other congenital foot defects, such as Calcaneovalgus and Metatarsus adductus. These deformities are caused by the position of the foot in the womb and are usually corrected with minimal intervention. True clubfoot affects all the joints, tendons and ligaments in the foot and is often referred to as Congenital Talipes EquinoVarus. Another form of clubfoot is Congenital Vertical Talus, this is not as common as true clubfoot, the foot appears more rigid then a true club foot deformity. In most cases, clubfoot is idiopathic, which means that the cause is unknown and there is no genetic tendency. However it is associated with Spina Bifida and Hip Dysplasia.

  APPEARANCE

• High arched foot that may have a crease across the sole of the foot.
• The heel is drawn up.
• The toes are pointed down.
• The bottom of the foot (heel) is pointed away from the body. Thus, the foot is twisted in towards the other foot (please refer to photograph below)

• The foot and leg may be smaller in comparison to a comparatively normal child.
• The foot will lack motion and be noticeably stiff.
• The calf muscle may also be smaller.

 SYMPTOMS

• If left untreated the child will walk on the outer top surface of the foot.
• The patient may also experience corns, hard skin and in growing toenails.
• Clubfoot in adulthood can lead to difficulty in purchasing shoes and a gait abnormality (walking pattern).

 WHAT YOU SHOULD NOT DO

• DO NOT ignore this condition in a hope that it will spontaneously disappear.

 WHAT YOU SHOULD DO

• Seek immediate advice from a pediatric consultant.
• Seek as many opinions as you can before you commence a treatment regime.

 TREATMENTS

There are many treatments available for clubfoot and many different opinions exist concerning treatment regimes.

The aim of the treatment regime should be: -

1. Correct the deformity early.
2. Correct the deformity fully
3. Hold the correction until growth stops.

Below is the summary of some of the main conditions.

 Casting

• This may be begin from the 1^st day of life to several weeks after birth.
• The foot is pushed and twisted into an over corrected position by the Orthopedist. The cast is then applied in order to hold the foot into that position. This may be uncomfortable for the child.
• Casts are usually changed every two weeks.
• Splints or braces may be used after a few years of casting the feet.

• The Ponseti method of casting and manipulation can also be effective. This method was pioneered in the 1940's by Dr Ignocio Ponseti and can be successful in certain cases. Please refer to your consultant for further information.

Surgery

There are many surgical procedures available for clubfoot. Surgery is usually recommended to a child of six months old. Below are the list of commonly used surgical procedures. For further information concerning these surgical procedures, please consult an Orthopedist.

• Perctuneous tenotomy. The Achilles tendon is cut to allow the foot to drop.
• Posterior release.
• Medial release.
• Subtarsal release.
• Complete tendon transfer.

  Physiotherapy

• This is primarily a non-surgical treatment that can begin when the child is three months old.
• It involves frequent visits by a physical therapist who tapes and/or manipulates the foot. This method has proved highly successful in some cases.

 WHAT THE CHIROPODIST WILL DO

• Refer you to a pediatric consultant or a physical therapist.
• In adulthood, the chiropodist will treat any foot conditions that may arise due to clubfoot, i.e. Corns.
• The chiropodist may customize insoles or shoes for the patient.

 CONDITIONS THAT RESEMBLE A CLUB FOOT

• Calcaneovalgus
• Metatarsus Adductus