What Is Talipes Equinovarus and How Is It Treated?

Introduction

Talipes equinovarus (TEV) or commonly known as clubfoot, is a congenital foot and ankle deformity. Infants born with this deformity show a foot that is turned inward. In severe cases, the bottom of a newborn's foot faces upward or sideways. 

In spite of the deformity, clubfoot during infancy is not painful. However, if clubfoot is left untreated, the child's foot will remain deformed and will be unable to walk normally as he or she grows. The good news is that early and proper treatment of clubfoot usually leaves minimal traces of deformity, allowing children to enjoy a variety of physical activities. Treatment often begins shortly after babies are born and can be successfully treated using nonsurgical methods, which may involve a combination of bracing, casting, and stretching.  

Symptoms

A child with clubfoot might have the following appearances on his or her foot:

• Inward and twisted downward appearance of the top of the foot
• Heel turning inward
• Increased arch
• Tight or short Achilles tendon
• Shorter or smaller than the other foot
• Underdeveloped calf muscles in the affected leg
• Twisted foot

Clubfoot can also occur in one or both feet, so these symptoms can also be expected to occur in one or both feet. 

Causes of Clubfoot

The cause of clubfoot is still unknown. However, this deformity appears to be a result of a combination of environmental and genetic factors (1, 2).

Risk Factors

Below are some risk factors for clubfoot:

• Family History: Babies are more likely to have clubfoot if one of their parents or siblings have had clubfoot. 

• Environment: Pregnant women who smoke and with a family history of clubfoot have an increased risk of having babies with the deformity than those who did not smoke during pregnancy. Women who also use recreational drugs or develop an infection during pregnancy may increase the risk of clubfoot. 

• Low Amniotic Fluid: The risk of clubfoot may also increase when there is not enough amniotic fluid in the mother's womb during pregnancy. 

• Other Birth Defects: Other congenital defects, such as spina bifida, can also be associated with clubfoot. 

Treatment 

A newborn's bones, tendons, and joints are quite flexible. For this reason, clubfoot treatment often begins within 1-2 weeks after birth. Treating clubfoot will help improve the appearance and function of children's feet before they start learning how to walk. Another goal of clubfoot treatment is to prevent long-term disabilities in children. Treatment may include nonsurgical and surgical methods. 

1. Nonsurgical Treatment

Regardless of the severity of the deformity, clubfoot is initially treated using nonsurgical methods. These methods include the Ponseti method and the French method. 

Ponseti Method

The Ponseti method is a widely used nonsurgical technique, which gradually corrects deformities related to clubfoot. Ideally, this treatment method should begin shortly after a baby is born. However, this method can also be successfully used in older babies. The elements involved in this method are:

• Casting and Manipulation: An infant's foot is held in place using a cast from toes to thigh. With this method, the infant's foot is repeatedly but gently stretched and repositioned with a cast until improvements are seen, which usually takes about 6-8 weeks. 

• Achilles Tenotomy: After weeks of casting and manipulation, most infants will undergo a minor procedure called a tenotomy to release the tightness in the baby's heel cord or Achilles tendon. To protect the child's tendon as it heals, a new cast will be applied, which often takes up to three weeks. When the cast is removed, the child's Achilles tendon has already regrown to a proper length, fully correcting the clubfoot. 

• Bracing: Although clubfeet can be successfully corrected with casting, there is still a chance for the deformity to naturally recur. To make sure that the baby's foot permanently stays in the proper position, a brace will be worn for a few years. Bracing will keep the baby's foot at a correct angle to maintain in proper position. For the first three months of the baby's life, the brace will be worn all the time. The doctor will eventually decrease the time to just nap time and overnight until the child reaches 3-4 years old. 

French Method

This nonsurgical method involves mobilization, stretching, and taping. Also called as the physical therapy or functional method, the French method is usually directed by a physical therapist, who specializes in the promotion, restoration, and maintenance of optimal physical function. 

The same with the Ponseti method, this method also ideally begins soon after childbirth. In this method, the infant's foot is stretched and manipulated every day and then taped to keep the range of motion obtained by manipulation. A plastic splint is then placed over the tape to help maintain any improved range of motion. This type of treatment usually requires a visit to the physical therapist three times a week.   

The child's parents will also be taught by the physical therapist on how to correctly perform this daily regimen at home. Significant improvements are usually observed after three months of therapy. However, this daily regimen must be continued until the child turns 2-3 years old to prevent the natural recurrence of clubfoot. 

2. Surgical Treatment

Most nonsurgical methods are successful when it comes to treating clubfoot. However, in some cases, the deformity recurs or cannot be fully corrected because parents tend to have a hard time following the treatment program. In other cases, deformities are so severe, making stretching ineffective. In such cases, surgical treatment may be required to help adjust the joints, tendons, and ligaments in the child's foot and ankle. 

An orthopedic surgeon can extend the length of tendons and help ease the child's foot into proper position. The child will be in a cast for approximately two months after surgery. The child then needs to wear a brace for 12 months or more to help prevent the recurrence of the clubfoot. 

Outlook

A child with clubfoot may not always obtain full correction even with treatment. However, most infants who are early treated tend to grow up wearing regular or conventional shoes and lead active normal lives.