A birth defect (commonly called club-foot) in which the foot is twisted out of shape or position.
The cause may be pressure on the feet from the mother’s uterus, or a genetic factor.
The most common form is an equinovarus deformity, in which the heel turns inwards and the rest of the foot bends down and inwards.
It is treated by repeated manipulation of the foot and ankle, starting soon after birth.
A plaster cast, splint, or strapping may be used to hold the foot in position.
If this is not successful, surgery will be needed.
Also known colloquially as club-foot, this is a deformity apparent at birth, affecting the ankle and foot: the foot is twisted at the ankle-joint so that the sole does not rest on the ground when standing. The heel may be pulled up so that the individual walks on the toes (talipes equinus); the toes may be bent up and the heel used for walking (talipes calcaneus); the sole may be twisted inwards (varus) or outwards (valgus); or the individual may have a combination of deformities (equinovarus). The condition is probably the result of genetic predisposition with an environmental trigger. In the UK the incidence is one in 1,000 live births and talipes is more common in boys than in girls, with 10 per cent of sufferers having a ?rst-degree relative with the same condition. Clinically, there are two types of congenital talipes equinovarus (CTEV): a milder form – resolving CTEV – in which full correction to the normal position is relatively easily achieved; and a more severe type
– resistant CTEV – which is harder to correct; and the infant has reduced calf-muscle bulk and abnormally shaped bones.
Treatment should be started at birth with the foot corrected to an improved position and then maintained in plaster of Paris or strapping
– a procedure performed weekly or more often. If the deformity is not corrected by around six weeks of age, a decision has to be made about whether to carry out surgical correction. If a deformity persists to maturity, a triple arthrodosis – fusion of three affected joints – may be required.
The passive movement (frequently forceful) of bones, joints, or soft tissues, carried out by orthopaedic surgeons, physiotherapists (see PHYSIOTHERAPY), osteopaths (see OSTEOPATHY) and chiropractors (see CHIROPRACTOR) as an important part of treatment – often highly e?ective. It may be used for three chief reasons: correction of deformity (mainly the reduction of fractures and dislocations, or to overcome deformities such as congenital club-foot – see TALIPES); treatment of joint sti?ness (particularly after an acute limb injury, or FROZEN SHOULDER); and relief of chronic pain (particularly when due to chronic strain, notably of the spinal joints – see PROLAPSED INTERVERTEBRAL DISC). Depending on the particular injury or deformity being treated, and the estimated force required, manipulation may be used with or without ANAESTHESIA. Careful clinical and radiological examination, together with other appropriate investigations, should always be carried out before starting treatment, to reduce the risk of harm, or disasters such as fractures or the massive displacement of an intervertebral disc.... manipulation
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