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Congenital Talipes Equinovarus(Clubfoot)

The term talipes is derived from of the Latin words for ankle(talus) & foot (pes).

The term refers to the gait of severely affected
patients, who walked on their ankles.
  • Clubfoot  is a severe fixed deformity of the foot characterized by fixed ankle plantar flexion (equinus), inversion of the subtalar (talocalcaneal) joint (varus), and medial subluxation of the talonavicular and calcaneocuboid joints (adductus)
  • Idiopathic majority , some  secondary to muscle pathology 
  • All the tissues of the foot i.e. bone, joint,ligaments and muscles have developmental abnormality
  • Bone: smaller in size, neck of talus is angulated so that head of talus is directed downwards  and medially. Calcaneum is small and concave  medially
  • Joints: equinus deformity  occurs primarily at ankle joint. Inversion deformity occur  in subtalar joint. Adduction occurs in midtarsal joints
  • Muscles and tendons: muscles of calf are underdeveloped.
  • Capsule and ligament: all the ligamentous structure on the postero-medial side of the foot shortened
  • Skin shows adaptive change
  • Callosities and bursae over  bony prominences on the lateral side
Congenital Talipes Equinovarus
  • Bilateral in 60%. 
  • General examination to rule out other deformities
  • Normally, the foot of newborn can be dorsiflexed until the dorsum touches the anterior aspect of shin of tibia
  • Components of the deformity:
  • Equinus.
  • Varus.
  • Adduction.
  • AP view and a lateral view in a position of maximum dorsiflexion. 
  • Kite angle is the angle subtended by the long axes of the calcaneus and the talus on the AP view. 
  • This angle is normally between 20 and 40 degrees. 
  • In the clubfoot, this angle is less than 20 degrees with relative parallel alignment of the talus and calcaneus. 
  • The relationship of the talus and calcaneus should also be assessed on the lateral view. Again, in the clubfoot, this shows relative parallel alignment compared with the normal foot

Nonoperative :
  • Best results are achieved with early manipulation.
  • (as early as first week of life) and serial casting (changed every 2 week).  Adduction deformity is corrected first followed by inversion and then equinus deformity. If this sequence is not followed rocker bottom foot may result 

Wearing Of Dennis-Browne(DB) splints for maintenance.

Good results may be achieved if previous technique is applied.

Operative Technique :
  • In less than 3 years only soft tissue release may be sufficient while older children require  bony operations.
  • Indicated for manipulation failure cases, recurrence and neglected cases
  • Posteromedial soft tissue release (PMSTR)
  • Tendon transfer
  • Dwyer’s osteotomy- open wedge osteotomy  of calcaneus
  • Dilwyn-Evan’s procedure : PMSTR with calcaneo-cuboid fusion
  • Wedge tarsectomy
  • Triple arthrodesis

1 comment:

  1. Thanks for sharing this useful information! Ponseti Method for clubfoot is one of the non-surgical method for clubfoot treatment in children. It consists of stretching and casting.