Club Foot

Presented by: Philip C. Centeno

Group CB30
What is club foot?
 A clubfoot, or congenital talipes equinovarus
(CTEV), is a congenital deformity involving one foot
or both.The affected foot appears rotated internally
at the ankle. It is classified into 2 groups: Postural
TEV or Structural TEV. Without treatment, persons
afflicted often appear to walk on their ankles, or on
the sides of their feet. It is a common birth defect,
occurring in about one in every 1,000 live births.
Deformities
 The deformities affecting joints of the foot occur at three
joints of the foot to varying degrees. They are:
 Inversion at subtalar joint
Deformities
 Adduction at talonavicular joint:
Deformities
 Equinus at ankle joint
Causes and Risk factors
 Talipes may be positional or structural.
 Positional talipes is caused by abnormal pressures
compressing the foot while it's developing, as a result of
its position in the womb.
 Structural talipes is a more complex condition and
caused by a combination of factors, such as a genetic
predisposition. Structural TEV is caused by genetic
factors such as Edwards syndrome, a genetic defect with
three copies of chromosome 18. Growth arrests at
roughly 9 weeks and compartment syndrome of the
affected limb are also causes of Structural TEV.
Causes and Risk factors
 It may also result from a condition called
oligohydramnios, where there's a shortage of
amniotic fluid around the baby in the womb.
 One in 1,000 babies is born with talipes. It's

twice as common in boys than in girls. A

genetic predisposition means it tends to run
in families.
Treatment
 Clubfoot is treated by manipulation. It is done
by providing braces to hold the feet in
orthodox positions, serial casting, or splints
called knee ankle foot orthoses (KAFO).
 In North America, manipulation is followed by
serial casting, most often by the Ponseti
Method. Foot manipulations usually begin
within two weeks of birth. Even with successful
treatment, when only one side is affected, that
foot may be smaller than the other.
Knee Ankle Foot Orthoses (KAFO)
Ponseti Method
 Ponseti Method – Applies certain techniques
to reduce and correct the deformity to
promote normal foot mobility and position.
Methods used are the following:
 Manipulation - Slightly pivoting the bones

and stretching the soft tissue

 Placement of above the knee cast

◦ Frequency of changing the cast is every 5-7 days

to accommodate the rapid growth during the first
year of life.
Ponseti Method

◦ In most cases, severing of Achilles tendon

(tenotomy) is done before the final cast is
applied. The reason for doing this is to loosen the
foot. The procedure is usually done in a clinic
where a local anesthetic is used. A small cut
(about 3 mm) is made above the heel of thefoot
to lengthen the tendon. After the procedure final
casting is done.
◦ Final cast is removed after 2-3 weeks when
Achilles tendon is already healed.
Ponseti Method

◦ After the final cast is removed:

 Denis Brown Splints (shoes or boots attached to a
bar) are used 23 hours each day for 3 months to
maintain the normal foot alignment. For the next
2-4 years the splint is fitted during naps and
nighttime only.
 Passive foot exercises (full range-of-motion) are
executed by the primary caregiver to further
maintain the position.
Casting
Braces