Club foot

Question 1

what is it?

Answer 1

TALIPES EQUINOVARUS

Question 2

pathogenesis

Answer 2

in utero abnormal alignment of joints between talus, calcaneus, navicular -
contractures of the soft tissues (ligaments, capsule & tendons) - 
ankle equinus (plantarflexion)
supination of forefoot
varus alignment of the forefoot

Question 3

who gets it?

Answer 3

boys:girls 2:1 
genetic link - +ve Fhx 
more common in breech presentation 
oligohydramnios - another risk factor 
occasionally part of another skeletal dysplasia 
50% bilateral

Question 4

how is it investigated?

Answer 4

diagnosis usually obvious

Question 5

how is it managed?

Answer 5

early splintage – Ponseti technique: progressive correction, 5-6 weekly cast changes
o 80% require a tenotomy of Achilles tendon to maintain full correction
o full correction achieved: brace consisting of boots attached to a bar
- 23 hours a day for 3 months
- during sleep until the age of 3-4 (prevent recurrence)
delayed presentations – uncommon – can result in fixed deformity = walking outside of foot
late deformity very difficult to correct: extensive surgery (soft tissue +/- bony procedures)
surgery may be required for cases resistant to splintage