Club Foot

Congenital Talipes Equinovarus

Talipes equinovarus (once called club foot) is a deformity of the foot and ankle that a baby can be born with. It is not clear exactly what causes talipes. In most cases, it is diagnosed by the typical appearance of a baby's foot after they are born. 

The Ponseti method is now a widely used treatment for talipes. This treatment gives good results for most children and so surgery is not usually needed to correct the foot deformity.

What causes talipes?

It is not clear exactly why talipes develops. It is thought that there may be genetic factors involved. If you have had a baby born with talipes, there is about a 3-4 in 100 chance that a brother or sister born after them will also have the condition. Babies born to a parent who has talipes also have an increased risk of being born with talipes themselves. If both parents have talipes, this risk is higher. Talipes may also have something to do with the position of the baby's foot when the baby is in the womb.

In most cases (around 4 out of 5), the baby has no other problems apart from the talipes. However, in around 1 in 5 babies who are born with talipes, there is also another problem. These problems may include:

• Spina bifida - a condition where the bones of the spine don't form properly, which can lead to damage to the nerves of the spine.
  
  
• Cerebral palsy - a general term that describes a group of conditions that cause movement problems. See separate leaflet called Cerebral Palsy for more details.
  
  
• Arthrogryposis - a condition where a child has curved and stiff joints and abnormal muscle development.

How is talipes diagnosed and are any investigations needed?

Talipes was previously only diagnosed after a baby is born. However, as the technology of ultrasound scanning during pregnancy improves, increasingly, talipes is being detected during scanning before a baby is born.

All babies in the UK are routinely examined and checked over by a doctor shortly after they are born. The doctor will look for talipes, as well as other problems that the baby may be born with. If the baby has talipes it is usually noticed during this check. Investigations such as X-rays are not usually needed to confirm the diagnosis.

Some babies with talipes have milder foot deformity than others. If a baby is diagnosed with talipes, a specialist (usually an orthopaedic surgeon) will often use a grading system to grade the severity. A common grading system that is used is called the Pirani score. With this grading system, a grade from 0 to 6 is given. The higher the grade, the greater the degree of foot deformity.

What is the treatment for talipes?

Ponseti method

The Ponseti method is now the preferred treatment by orthopaedic surgeons throughout the world. Major surgery used to be common; however, medical research has shown that the Ponseti method gives better long-term results for most children.

This method involves the specialist gently manipulating (holding, stretching and moving) the child's foot with their hands, into a position in which the foot deformity is put right (corrected) as much as possible. This is not painful or uncomfortable for the child. Once in this position, a plaster cast is put on to hold the child's foot in position. This plaster cast usually goes all the way from the child's toes to their groin area.

After one week, the plaster cast is removed, the child's foot is manipulated again and a plaster cast is put back on with the child's foot in the new position. After another week, this procedure is repeated. As each week goes by, usually the child's foot is able to be moved into a position that becomes closer and closer to a normal foot position.

After around six weeks of repeated manipulation and plaster casting of the foot, there is usually good progress and the foot position has improved. At this stage, a small operation is suggested for most children, called an Achilles tenotomy. This involves releasing the tight Achilles tendon at the back of the foot, using a small cut so that the heel can drop down. It is a minor operation and it can usually be done with just a local anaesthetic.

After this, their foot is put in a final plaster cast, usually for three weeks. The child will then need to wear some special boots that are connected together with a bar. They will need to wear these for 23 hours a day for three months. After this they generally just need to wear the 'boots and bar' at night or during sleep periods until they are 4 years old.

It is really important for the child to continue to wear their 'boots and bar' as the specialist advises. If the boots and bar are not worn as advised, there is a chance that talipes can come back.

It is important that a baby who has talipes be referred to see a doctor specialised in treating this problem as soon as possible after birth. The sooner Ponseti method treatment is started, in general, the easier the correction of the foot deformity should be.

Other methods

Other treatment methods are available. One example is the French functional method, which involves daily manipulation as well as immobilisation with adhesive bandages and pads.

Source: patient.info

RIVERA FOOT & ANKLE: At Orlando H.Rivera DPM, our priority is to deliver quality care to informed patients in a comfortable and convenient setting. When you have problems with your feet, you need to turn to a podiatrist who listens and responds… an experienced doctor who knows the field and can effectively diagnose and treat your needs… a friendly physician who counsels you on the best ways to maintain and improve your health. Our physician(s) meet all these criteria. Plus, you benefit from a dedicated team of trained professionals who give you the individualized attention you deserve.

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