pediatrics
Talipes Equinovarus (Clubfoot) and Other Foot Abnormalities
Introduction
Talipes equinovarus, sometimes called clubfoot, is characterized by plantar flexion, inward tilting of the heel (from the midline of the leg), and adduction of the forefoot (medial deviation away from the leg’s vertical axis). (See also Introduction to Congenital Craniofacial and Musculoskeletal Abnormalities .) Talipes equinovarus results from an abnormality of the talus. It occurs in about 2/1000 live births, is bilateral in up to 50% of affected children, and may occur alone or as part of a syndrome. Developmental Dysplasia of the Hip (DDH) is more common among these children. Similar deformities that result from in utero positioning can be distinguished from talipes equinovarus because they can be easily corrected passively. Larsen syndromeis a disorder in which children are born with clubfeet and dislocations of the hips, knees, and elbows. Treatment of clubfoot requires orthopedic care, which consists initially of repeated cast applications, taping, or use of malleable splints to normalize the foot’s position. If casting is not successful and the abnormality is severe, surgery may be required. Optimally, surgery is done before age 12 months, while the tarsal bones are still cartilaginous. Talipes equinovarus may recur as children grow. Other foot abnormalities include metatarsus adductus, metatarsus varus, talipes calcaneovalgus, pes planus, flexible flat feet, and tarsal coalition. 