Club Foot / Talipes

Club Foot (Talipes)

Deformities of the ankle and foot ("talipes" = ankle-foot)
1. Develop in utero and usually present at birth
  - Structural TEV: Genetic factors - Edwards syndrome (Chr18);
  - Postural TEV: caused by external influences in the final trimester - uterine compression from oligohydramnios; amniotic band syndrome; breech presentation
2. Develop in adult life after injury, paralysis and other musculoskeletal disorders
Classified according to skeletal deformity

Nerves and arteries usually normal when the abnormality is a congenital skeletal deformity

May be neurological abnormalities if the deformity has been acquired since birth

Types of Deformity:

Abnormal ankle extension (plantar-flexion) = equinus deformity: end up walking on toes
Abnormal ankle dorsiflexion = calcaneous deformity
Abnormal ankle varus/inversion
Abnormal ankle valgus/eversion

Therefore there are 8 types of deformity possible at the ankle joint

Simple
1. Talipes varus
2. Talipes valgus
3. Talipes equinus*: - short achilles tendon
4. Talipes calcaneous
Mixed
1. Talipes equinovarus*
2. Talipes equinovalgus
3. Talipes Calcaneovarus
4. Taliopes Calcaneovalgus

Treatment of Club Foot

Conservative:
1. Treated by manipulation / podiatry / physiotherapy / orthopaedic surgeons
2. Braces to hold the feet
3. Serial casting
4. Splints / Knee-Ankle-Foot-Orthoeses
5. Ponseti Method:
  - Ligaments, joints, tendons stretched under manipulations
  - Plaster cast applied after each manipulation to retain degree of correction
  - Bring displaced bones back into the correct alignment
Surgical:
1. Tenotomy (80% of cases): release of the achilles tendon done under LA
2. Anterior tibial tendon transfer: tendon moved from 1st rate to the 3rd ray - release inward traction on the foot
NB if surgery - scarring may result in functional, growth and aesthetic problems with childs foot (and therefore may need later corrective surgery)

www.surgicalnotes.co.uk