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Club foot

CTEV; talipes; club; foot; congenital; rigid; positional; equino; varus; TEV; feet ;

A small number of children have what is commonly known as 'club foot' at birth. The correct name is congenital talipes equino varus (CTEV).  Congenital means occurring from birth.  Talipes means foot deformity.  Equino varus describes the position of the foot - toes pointing downwards and the whole foot turned inwards.

Contents

There is a less serious condition which also is there from birth which is known as positional talipes equino varus or TEV.

Positional TEV

  • Positional TEV is not a club foot and it can be corrected easily.
  • It is caused by the baby's position in the uterus (womb) before birth, and there are no serious bone or muscle problems involved.
  • It is corrected by stretching, or sometimes a splint may be necessary.
  • Once the foot is in the normal position there should be no more problems with the foot.

CTEV - Club foot
  • CTEV occurs about once in 1000 births and is more common in boys.  It can happen in either foot or sometimes both feet.
  • It requires intensive treatment and long term followup, however the likely outcome is good.
  • It involves muscular and bony abnormalities, wasting of the calf muscle (the calf muscle is thinner than usual) and often a slightly smaller lower leg and foot.
  • The foot points downwards and the sole of the foot turns inwards and is curved around.


picture of baby with club foot 
Picture of baby with club foot courtesy of Talipes Information And Parental Support Group (TIPS)

  • The calcaneus (heel bone) is inverted (turned in) and the Achilles tendon (at the back of the heel) is tight.
  • Some of the joints in the foot may be affected and the front part of the foot turned in.
  • The muscles and ligaments on the inside of the foot and ankle are also tight and on the outside of the foot and ankle they are loose and stretched.

Cause of club foot
  • There have been several suggested causes but at this stage it is not know what the causes are.

Treatment

Treatment may vary in different places, but usually physiotherapy and often orthopaedic surgery (an operation) is needed.

In South Australia babies are treated with the Ponseti method.

  • Plasters are applied soon after birth to begin to straighten the foot as gently as possible by stretching the tight structures.
  • The plasters are changed often (5 to 7 days) as the foot position improves, and they are not painful for the baby. Most babies need about 5 casts.
  • Minor surgery to lengthen Achilles tendon is usually needed. After surgery another cast is made which stays on for three more weeks.
  • Following this the baby has to wear boots which are connected by a bar, so the baby cannot move his or her legs, for 23 hours a day for 3 months.
  • After this the boots are worn at night and "nap" time until your child is approximately 4 years old. During the day ordinary well-fitting shoes can be worn.
  • The child's feet need to checked regularly, as occasionally the CTEV may relapse (come back) until the child is about 7 years of age, especially if the treatment is not continued.

With this treatment, children with CTEV go on to have normal active lives. Their feet are likely to look normal and be pain-free with good movement, although one foot may be a different size to the other if only one foot was affected.

Resources

In South Australia a baby with club foot will be treated at the Women's and Children's Hospital in the Orthopaedic and Physiotherapy departments.
http://www.wch.sa.gov.au

Aussie Club Foot Kids - a parent information and support site (including information about the Ponseti procedure)
http://www.aussieclubfootkids.org/

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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