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 Disorders.)
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 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 syndrome is 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.
Talipes calcaneovalgus
The foot is flat or convex and dorsiflexed with the heel turned outward. The foot can easily be approximated against the lower tibia. Developmental dysplasia of the hip is more common among these children.
Early treatment with a cast (to place the foot in the equinovarus position) or with corrective braces is usually successful.
Metatarsus adductus
The forefoot turns toward the midline. The foot may be supinated at rest. Usually, the foot can be passively abducted and everted beyond the neutral position when the sole is stimulated. Occasionally, an affected foot is rigid, not correcting to neutral. Developmental dysplasia of the hip is more common among these children.
The deformity usually resolves without treatment during the first year of life. If it does not, casting or surgery (abductory midfoot osteotomy) is required.
Metatarsus varus
The plantar surface of the foot is turned inward, so that the arch is raised. This deformity usually results from in utero positioning. It typically does not resolve after birth and may require corrective casting.
Pes planus (flat feet)
In pes planus (flat feet), the normal arch in the middle of the feet appears flattened. Until about 3 years of age, all children have flat feet and then the arch begins to develop. There are two main reasons for flat feet:
Flexible flat feet
Tarsal coalition
In flexible flat feet, the feet remain flat because the arch of the foot is unusually flexible. Flexible flat feet usually do not require treatment. However, if an older child has pain or cramps in the feet, corrective shoes may be needed.
In tarsal coalition, the feet are fixed in a flattened position. Tarsal coalition may be a congenital defect or result from conditions such as injuries or prolonged swelling. Treatment of tarsal coalition often includes a cast. Sometimes surgically separating the stiffened foot joint restores mobility to the foot.
