Condition in which a newborn's foot or feet appear to be rotated internally at the ankle
Aetiology
In utero abnormal alignment of the joints between the talus, calcaneus and navicular (7th week of embryo development)
Around 50% of cases are bilateral
More severe club feet associated with syndromes
Risk factors
More common in males
Family history
Breech presentation
Oligohydramnios
Pathophysiology
The abnormal alignment of the joints between the talus, calcaneus and navicular results in contractures of the soft tissues (ligaments, capsule and tendons) resulting in a deformity consisting of ankle equinus (plantarflexion), supination of the forefoot and varus alignment of the forefoot
Clinical presentation
Postural talipes - feet turned in at birth but will stretch out with mild physiotherapy
Club foot - structural malformation of the bones and muscles of the foot involving resulting in ankle equinus (plantarflexion), supination of the forefoot and varus alignment of the forefoot
Management
Diagnosis normally obvious, treatment commenced as soon as possible after birth
Ponsetti technique - splinting and casting
Deformities are corrected progressively in stages and held in plaster casts with 5 or 6 weekly cast changes
80% of children require a tenotomy of the Achilles tendon to maintain full correction
Surgery may also be required for cases resistant to splintage
Once full correction is achieved the child is then placed in a brace consisting of boots attached to a bar which is worn 23 hours a day for 3 months and used during sleep until the age of 3 to 4 to try to prevent recurrence
Late deformity is very difficult to correct and requires extensive surgery with less satisfactory results however delayed presentations are very rare in modern healthcare systems
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