This document summarizes congenital talipes equino varus, or club foot, which occurs in approximately 1-2 per 1000 live births. Club foot is characterized by an inverted heel, hindfoot varus, and forefoot adduction and supination. It is caused by unknown factors that may include genetic defects or abnormal positioning in the womb. Treatment involves manipulation, casting, and sometimes surgery to correct contractures and produce a plantigrade foot.

1.  Congenital Talipes EquinoVarus
 Club foot
 Talipes(Latin) – Talus + Pes (Foot)

2.  Heel - Equinus
 Hind foot – Varus
 Fore foot – Adduction & supination
Cavus foot
Internal tibial torsion

3.  Associted problems
Constricted Annular rings
(Streetere’s syndrome)
Tibial deficiency
Inguinal hernia
CDH
Spina bifida

4.  1-2 per 1000 live births
 Boys : Girls – 2:1
 Common in left
 Bilateral in 50%

5.  Unknown cause
 Germ plasm defect
 Development defect
 Neurologic/Neural tube defects
 Abnormal position in utero
 Arthrogryposis

6.  Pathoanatomy
 Joints
Equinus ankle & subtalar
 Bone
Posterior displacement Lat. Malleolus
Medial rotation & inversion talus
Medial angulation of neck of talus
Medial rotation, equinus Calcaneus
Medial rotation, equinus of navicular

7.  Ligaments
Contracture of Spring lig.
Bifurcarcated Y lig
Deltoid lig.
Calcaneo-fibular lig
Talo fibular lig.

8.  Tendons
Tibialis posterior
FHL
FDL
FDB
Tendo Achillis
Abductor hallucis
Plantar aponeurosis
Tibialis anterior
EHL

9.  Master knot of Henry’s
Fibrous sheath envelops FHL&FDL
Bind the medial & plantar side of
naviculum

10.  Present at birth
 Small, bean shaped foot
 Ankle in equinus
 Fore foot adducted & supinated
 Heel inverted, small & high
 Cavus foot
 Deep posterior & medial creases
 Prominent talar head dorso laterally
 Tight Tendo achillis

11.  Antero-posterior View
Kite’s angle
Talo-calcaneal angle
normal 20-40 degrees
 Lateral view
in forced dorsiflextion
Line thru longitudinal axis of
talus
and that of calcaneum
Normal 30 –40 degrees

12.  AIM
To produce & maintain plantigrade, supple
& functionally near normal foot

13.  Conservative Mx
1.Manipulation by parents- 1-2 days
post birth
2.Manipulation and strapping
3.Serial corrective casting
Forefoot adduction
Heel varus
Equinus

14.  Surgical Mx
Indications
Resistant CTEV (after 8-12 wks
cons mx)
Late presentation
Rigid CTEV
Arthrogryposis
 Time of surgery
6-9 months

15.  Soft tissue procedures
Postero medial release
Turco’s release
TA lengthening

16.  Post Operative management
Dennis brown splint/shoes x 3
months

17.  Ilizarov
 Jess fixator
 Tripple arthrodesis
 Dilwyn Evans
osteotomy
 Dwyers osteotomy

18.  Rocker bottom deformity
 Recurrence
 Residual deformity
 Flat top talus