Talipes Equinovarus
1 to 2 per 1000 live births. 50% are bilateral. M>F.
Aetiology:
Cause unknown (or controversial), but resemble the foetal foot at about the 7th to 9th week. Associated with a number of diseases (eg spina bifada, myelomeningocele, congenital hip dislocation), but most are idiopathic. Almost all diagnosed at birth.
Classification:
1) Idiopathic/congenital
2) Positional (deformed by in-utero pressure; can be easily reduced; prognosis better than idiopathic)
3) Teratologic (has other deformities (eg congenital hip dysplasia); more severe with poor prognosis)
4) Syndrome (genetic; part of a syndrome; eg Larsen syndrome )
Pathological anatomy:
Adducted forefoot; inverted hindfoot; ankle equinus; plantar medial displacement of the navicular on the head of the talus; lateral rotation of the body of the talus in the ankle mortise; posterior deviation of the lateral malleolus; medial subluxation of cuboid on the calcaneus; soft tissue contractures; calf muscles are atrophied; anterior tibial blood vessel anomalies are common; plantarflexor and inverter muscles are shorter; tendon sheaths are thicker.
Clinical features:
Plantarflexed and inverted position of foot; medial malleolus abuts navicular; talus head is prominent dorsolaterally; forefoot is adducted; variable rigidity; mild calf atrophy; radiographic changes (measurements difficult due to small size of ossification centres).
Treatment:
Early recognition is important for better prognosis as treatment should be begin at birth.
Initially manipulation and casting – later surgical.
Manipulation –
Casting – 2x a week initially; after 1 month of age weekly.
Surgery –
Long term sequelae:
Sign of surgical correction – creasing plantar and medial to talonavicular area.
Rocker bottom foot – occurs when surgical correction dorsiflexes forefoot on rearfoot rather than at ankle.
Flat top talus – range of ankle joint motion is decreased
Navicular wedging – due to compressive forces used to correct clubfoot.
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