Updated: 12/26/2021

Talipes Equinovarus (Club Foot)

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  • Snapshot
    • A newborn boy is evaluated for a foot deformity. He was born at 37 weeks gestation via a spontaneous vaginal delivery. The mother's pregnancy has been uneventful and she has been taking her prenatal vitamins. On physical exam, the patient's right foot is slightly smaller than the left. The foot is plantar flexed, medially swung, and has an inward facing sole. Preparations are made to perform serial casting via the Ponseti method.
  • Introduction
    • Clinical definition
      • developmental foot deformity characterized by
        • plantar flexion of one or both feet
        • medially swung forefoot
        • inward facing sole
  • Epidemiology
    • demographics
      • more common in male fetuses
  • Etiology
    • idiopathic
    • intrinsic causes
      • e.g., fetal onset neurologic or muscular disease
    • extrinsic causes
      • e.g., uterine cavity abnormalities
  • Presentation
    • Physical exam
      • the foot is
        • plantar flexed (can be both feet)
        • forefoot is medially swung
        • soles are inward facing
      • heel can't go flat on a surface
  • Imaging
    • Radiography
      • indication
        • can provide a baseline before and after surgical correction of the foot
          • imaging is not typically required
  • Studies
    • Making the diagnosis
      • a clinical diagnosis
  • Differential
    • Metatarsus adductus
      • distinguishing factor
        • most common congenital foot abnormality
        • on physical exam there is medial deviation of the forefoot while the hindfoot is in a normal position
          • a "C" shaped concavity is formed
  • Treatment
    • Conservative
      • serial manipulation and casting (Ponseti method)
        • indication
          • a corrective modality to address the foot deformity
    • Operative
      • orthopedic surgery
        • indication
          • in patients refractory to conservative treatment
  • Complications
    • Disability
    • Complications secondary to surgical treatment
      • e.g., infections
  • Prognosis
    • About half the cases can be nonoperatively treated
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(M2.OR.15.123) A 4-month old boy presents for follow-up in the orthopedic clinic. At birth, he was diagnosed with the condition pictured in Figure A, and has undergone stretching and serial casting since then. On exam, his right foot is still turned inward and cannot dorsiflex beyond 85 degrees. The joint feels rigid. What is the most appropriate next step?

QID: 105521
FIGURES:

Surgical treatment before 12 months of age

27%

(22/83)

Surgical treatment after 24 months of age

19%

(16/83)

Surgical treatment after continued conservative therapy

17%

(14/83)

Continued casting with delayed physical therapy

7%

(6/83)

Continued casting with immediate physical therapy

28%

(23/83)

M 7 E

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