Congenital Talipes Equinovarus (Club Foot): Overview, and Management Options
Talipes equinovarus also called clubfoot, the pes equinovarus is characterized by plantar flexion, inversion of the heel (from the midline of the leg) and adduction of the foot (medial deviation from the vertical axis of the leg). Although the clubfoot is the most common congenital skeletal deformity, along with congenital hip dislocation, and there is an immense number of publications, there is still no clarity about the optimal therapeutic approach. The value of a therapy only becomes apparent in the long term. Talipes equinovarus results from an anomaly of the talus. It occurs in 2 in 1000 live births and is bilateral in 50% of the affected children. It can appear alone or as part of a syndrome. A developmental hip dysplasia is more common in these children. Similar deformations that resulted from a sitting position in the uterus can easily be distinguished from clubfoot, as they can easily be corrected passively. The Larsen syndrome is a disorder that occurs in children with clubfoot and dislocations of hip, knee and elbow. The treatment of clubfoot requires great orthopaedic care and initially consists of repeated plaster applications, tapes or the use of a malleolar splint to bring the foot position into the correct position. If the cast is unsuccessful and the posture is severe, an operation may sometimes be necessary, which is best before the age of 12. Optimally, an operation before the age of 12 while the tarsal bones are still cartilaginous. Club feet can recur as children grow.