1. Talipes Equinovarus (TEV)
The formal name for clubfoot is talipes equinovarus (TEV). In this condition, the bones of the ankle are turned down (equinus) and in (varus). It looks as if the sole of the foot is facing the other foot, such that the person is walking on the outside of their foot. It occurs in approximately one in a 1,000 births. About half the time, it is present on both feet. It is more common in boys than girls. Clubfoot affects the entire leg, and the leg may be shorter overall. The calf is atrophic, and the foot itself is also shorter.
2. Causes
No one is sure of the exact cause for clubfoot, but there is definitely a genetic component. Parents with clubfeet are more likely to have children with clubfeet. Even with normal parents, having a child with clubfoot increases the likelihood of having another child with clubfoot. Some other suggested causes are interuterine positioning (positioning within the womb) or breech births (babies positioned head up instead of head down), but nothing is certain. Clubfoot can also occur as a component of more serious birth disorders, such as spina bifida.
3. Diagnosis
Most times, the diagnosis is obvious at birth, with the characteristic position of the foot. While the infant is young, the bones, tendons and joints are more malleable and have a higher chance of being corrected. Ideally, the child should see the pediatric orthopedist within a week or two of diagnosis.
4. Tretment
Dr. Ponseti, of the University of Iowa, devised a method to treat clubfoot without surgery. It involves a series of plaster casts to realign the foot bones, but must be started within the first five to seven days after birth for best results. There may be the need to perform a small office procedure involving cutting the heel cord (Achilles tendon) if the ankle is too tight. The child may need to wear special shoes/braces for a short time afterwards as well. When done by a certified physician, most cases of clubfoot will respond to the Ponseti method. The goal is a flat (plantigrade) foot that the child can eventually walk on. However, the foot will always be smaller than the other side, and the calf muscles thinner.
5. Surgery
Severe cases of clubfoot or patients with a later presentation may require surgery to realign the foot. This can involve cutting and rerouting tendons, or cutting and realigning bones. However, the foot will likely be stiffer and more painful than with the non-surgical method, which is why it is so important to treat clubfoot early.
