CLUBFOOT (Congenital talipes equinovarus - CTEV)
A true clubfoot, or congenital talipes equinovarus, is a structural deformity that presents in newborn babies. It affects the bones, muscles and ligaments in the foot, and the foot usually adopts a fixed adducted, inverted and plantarflexed position. In 50 percent of cases both feet will be involved.
It is important to be able to distinguish between a CTEV, and a Positional talipes equinovarus, which is a flexible positional condition that is thought to occur due to the position of the foetus in utero. A positional talipes equinovarus does not involve a bony deformity, and usually responds well to physiotherapy.
Clubfoot is one of the most common birth defects, and affects 1 in every 800 births. There is variation in countries and across certain ethnic groups. The Ponseti method is the 'gold standard' treatment for children with this condition; this involves a series of casting (and in a minority, minor surgery is needed), to gradually improve the position of the foot. The outcome is generally good for children identified and treated quickly. However unfortunately many children born with clubfoot in low or middle income countries have limited access to proper treatment.
All babies born with a talipes equinovarus should be examined by a paediatrician or paediatric physiotherapist, to distinguish whether the deformity is structural or positional in nature. Those with a structural clubfoot should be referred to a specialist paediatric orthopaedic team, who can commence treatment as soon as possible. If the foot position is found to be flexible, assessment should be sought from a paediatric physiotherapist, who can provide appropriate advice and stretches as necessary.