Clubfoot

Clubfoot (Talipes Equinovarus)

CONGENITAL
NUR2163

Types of clubfoot





What Causes Clubfoot?

1. unknown (idiopathic).
2. associated disorders or syndromes such as

developmental hip dysplasia, spina bifida,
arthrogryposis, or myotonic dystrophy.
3. several different pre-disposing factors:
i. Extrinsic: This type is usually mild and supple. The
cause can be due to intrauterine compression (large
baby, abnormally shaped or small uterus, or abnormal
intrauterine fluid levels).
ii. Intrinsic: This type is commonly more severe, rigid and
the calf muscle is smaller. The foot may be smaller and
there can be a bone deformity of the talus.

What is Clubfoot?

• known as talipes equinovarus (TEV)

• common foot abnormality

• the foot points downward and inward.

• (2:1) in males than in females

• For parents with no family medical history of
clubfoot, the chance is 1 in 1,000.

• if they already have a child with clubfoot, their
future children have a 3% (3 in 100) chance of
having the same abnormality.

• Parents who had clubfoot themselves have a 20-
30% chance of having a child with clubfoot.

• Care and management of this is a long process
beginning as early as 1 week old and lasting to
4-5 years old or older in some cases.

What are the Symptoms of Clubfoot?

1.Stiff, rigid, foot of varying degrees.
2.Short and/or tight Achilles tendon (heel

cord), with foot pointing downward.
3.The heel is turned in.
4.Deep heel crease; soft, puffy heelpad;

wide front foot area and overall smaller
foot.

How is Clubfoot Diagnosed?

• clubfoot can be noted during a prenatal
ultrasound.

• However, the severity of it cannot be determined
until after the child is examined and there is no
treatment until after the child is born.

• If the orthopedist feels a child has a clubfoot
associated with another condition or syndrome
or there are associated findings, the care-givers
will be given an explanation with orthopedic
treatment if needed and a referral to another
specialist as needed.

How is Clubfoot Treated?

• Dr. Ignacio Ponseti developed the Ponseti
method for treatment of clubfeet over 60
years ago.

• The success of treatment depends on the
overall flexibility of the foot and parents’
compliance with appointments for casting
and brace wear for 4 years or so.

• The bones in a newborn foot are mostly
cartilage, therefore they are easily
moldable/manipulated.

• We use the casting to slowly stretch the
tissues and move the foot into correct
position.

• This set of long leg casts requires weekly
visits to the Orthopedic Center to change
the foot position in an orderly method.

• There are typically 3-6 casts required to
complete the process.

• Infants will need to be sponge bathed
during this time.

• This process will not affect how they are
transported in car seats.

• Dr will ask parent to bring the infant hungry,
ready to be fed by a bottle (if possible)
during office visits. This will help calm the
child and provide better leg positioning if
they are still. A pacifier and/or toys are also
very helpful.

• Please bring extra diapers and wipes as the
plaster can adhere to the diaper and skin as we
apply the cast. The plaster does not hurt the skin
when we wipe it off.

• 80 to 90% of patients with clubfeet, (not
associated with other conditions), that are
treated with the Ponseti technique, will need a
small surgery .

• 10 to 20% of patients will require reconstructive
foot surgery when the child is 1-2 years old. This
number can be as high as 40%-50% if the shoes
and bar are not used for a full 4 years after
casting.

Surgical Treatment

• The tight heel cord may respond well to
stretching in casts.

• Many patients (80%-90%), will require a surgical
procedure called a Percutaneous Transverse
Achilles Lengthening (TAL).

• Some physicians perform this in an orthopedist
office with local anesthesia (such as lidocaine),
but most of the surgeons at Nationwide
Children's Hospital complete this in the
operating room under general anesthesia (fully
asleep).

• The procedure typically takes 15 minutes.

• By lengthening the heel cord, the heel is
able to drop down and align correctly for
normal standing.

Denis-Browne Bar and Shoes

• Once the casting is completed, the child
will be transitioned into a set of special
shoes to keep the foot in correct
alignment.

• The special pair of shoes with a bar
attached at the bottom will be made for the
baby. These are called Denis-Browne
Shoes and Bar and they are fit at an
orthotist office.

Dennis Brown Shoes with splint



• The shoes allow for the bar to be attached
to the feet so the foot/feet can be rotated
outward, maintaining the correct alignment
of the pre-bone cartilage as the foot
grows. These will be worn 23 of 24 hours
per day until the baby begins to
stand/walk.

• Then,the shoes will be used during naps
and bedtime (12 hours a day). This routine
will be maintained until the child is 4 to 5
years old or older.

Cast Care and Daily Concerns

• check the baby’s toes every hour or so during the first
day of casting with each cast change. This is to insure
the circulation is good. After the first day, the toes should
be checked about every 12 hours.

• Lightly pinching the toes should cause them to turn pale
and then return to pink within a few seconds. If the toes
are cool, dusky, and not “pinking up” after elevation and
vigorous toe motion, the cast may be too tight.

• Call the orthopedic center for instructions regarding
returning to the clinic or being seen elsewhere for cast
removal if the center is closed.

• If the foot is not properly aligned in the cast, the
correction will be lost.

Keep the Cast(s) Clean and Dry

The following is a list of events/issues that may
occur which would require the cast to be changed
sooner than 1 week intervals.

1. If the cast should become very wet- where it falls
apart, or if the cast literally falls off just from
kicking, please call.

2. If the baby seems to be crying more than usual
and seems to be in pain, and if the toes are not
maintaining a warm and pink appearance,
contact the office right away.

3. If the child has had a surgical procedure, and
the child should develop a temperature over
38°c through the night, treat the elevated
temperature and contact the orthopedic center
the next morning.